PICC静脉血栓类疾病危险因素预测在肝胆胰恶性肿瘤病人中的研究

Study on the PICC risk factors prediction of venous thrombosis in patients with hepatobiliary malignancies

目的:探究肝胆胰恶性肿瘤病人经外周静脉置入中心静脉导管(PICC)导管相关性血栓(CRT)的发生率及其危险因素。方法:回顾性收集102例肝胆胰恶性肿瘤病人的临床资料,统计CRT发生率,分析病人的基线资料以及PICC置管情况并对CRT相关因素进行单因素分析,将有统计学意义(P<0.05)的因素纳入logistic回归模型进行分析。结果:CRT的发生率为31.37%,单因素分析显示,CTR组病人无抗血小板或抗凝史、吸烟史、感染、远处转移、骨髓抑制、穿刺点异常率、体质量指数、导管直径高于非CRT组,差异均有统计学意义(P<0.05~P<0.01)。多因素分析显示吸烟、导管直径为<4-F/5-F、骨髓抑制、静脉炎、高体质量指数是肝胆胰恶性肿瘤病人并发CRT的独立危险因素(P<0.05~P<0.01)。结论:CRT好发于长期使用PICC的肝胆胰恶性肿瘤病人群体,且吸烟、骨髓抑制、穿刺点异常、静脉炎和导管直径为<4-F/5-F是肝胆胰恶性肿瘤病人CRT的独立危险因素。

Objective:To investigate the incidence rate and risk factors of peripherally inserted central catheter(PICC)catheter-related thrombosis(CRT)in patients with hepatobiliary malignant tumors.Methods:The clinical data of 102 patients with hepatobiliary malignancies were retrospectively analyzed.The incidence rate of CRT was counted.The relationship between the baseline data,placement of PICC and CRT were analyzed using the single factor method,and the factors with statistical significance were included in the logistic regression model for analysis.Results:The incidence rate of CRT was about 31.37%.The results of univariate analysis showed that no antiplatelet or anticoagulation history,smoking history,infection,distant metastasis,bone marrow suppression,abnormal rate of puncture site,BMI and catheter diameter in CRT group were higher tahn those in nonCRT group(P<0.05 to P<0.01).The results of multiple-factor analysis showed that the smoking,catheter diameter less than 4-F/5-F,myelosuppression,phlebitis and high BMI were the independent risk factors in patients with hepatobiliary malignant tumor complicated with CRT(P<0.05 to P<0.01).Conclusions:The CRT occurs predominantly in hepatobiliary malignancies patients treated with PICC for a long time,and the smoking,bone marrow suppression,abnormal puncture sites,phlebitis and catheter diameter less tahn 4-F/5-F are the independent risk factors of CRT in patients with hepatobiliary malignancies.