肺癌化疗患者PICC相关性血栓的现状及影响因素分析

Status and influencingfactors of PICCrelated thrombosis in lung cancer patients undergoing cancer chemotherapy

目的探讨肺癌化疗患者经外周静脉置入中心静脉导管(PICC)相关性血栓的现状及其影响因素。方法采用便利抽样法选取2020年6—12月郑州大学第一附属医院收治的259例肺癌化疗患者,记录其3个月PICC相关性血栓的发生情况。依据有无发生PICC相关性血栓分为血栓组(18例)与无血栓组(241例)。采用单因素分析和多因素Logistic回归分析探讨肺癌化疗患者PICC相关性血栓的影响因素。结果259例肺癌化疗患者PICC相关性血栓的发生率为6.95%(18/259)。单因素分析结果显示血栓组与无血栓组患者的肺癌分期、病理类型、有无合并症、置管肢体、导管材质、导管尖端位置、纤维蛋白原(Fg)及D-二聚体(D-D)水平比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,Ⅲ~Ⅳ期肺癌、导管材质聚氨酯、导管尖端位置在上腔静脉上2/3、Fg>4 g/L、D-D≥0.4 mg/L是肺癌化疗患者PICC相关性血栓的危险因素(P<0.05)。结论肺癌化疗患者发生PICC相关性血栓与肺癌分期、中心静脉导管材质、导管尖端位置、Fg及D-D水平有关,临床应选择适合患者的导管,密切监测凝血相关因素,以降低PICC相关性血栓发生风险。

Objective To explore the status and influencing factors of peripherally inserted central catheters(PICC)related thrombosis in lung cancer patients undergoing chemotherapy.Methods From June to December 2020,a total of 259 lung cancer patients undergoing chemotherapy in the First Affiliated Hospital of Zhengzhou University were enrolled using the convenient sampling method,and the occurrence of PICC related thrombosis within 3 months was recorded.Patients were divided into the thrombus group(18 cases)and the non-thrombosis group(241 cases)according to the occurrence of PICC associated thrombus.Univariate and multivariate Logistic regression analysis were used to explore the influencing factors of PICC related thrombosis in lung cancer patients undergoing chemotherapy.Results The incidence of PICC related thrombosis of 259 lung cancer patients undergoing chemotherapy was 6.95%(18/259).Univariate analysis showed that there were significant differences in lung cancer stage,pathological type,complications,catheter placement limb,central venouscatheter material,catheter tip position,fibrinogen(Fg)and D-dimer(D-D)between the thrombosis group and the non-thrombotic group(P<0.05).Multivariate Logistic regression analysis showed thatⅢ-Ⅳstage lung cancer,polyurethanecatheter,catheter tip position was 2/3 upper of the superior vena cava,Fg>4 g/L and D-D>0.4 mg/L were the influencing factors of PICC related thrombus in lung cancer patients undergoing chemotherapy(P<0.05).Conclusions PICC related thrombosis in lung cancer patients undergoing chemotherapy is related to lung cancerstage,central venous cathetermaterial,catheter tipposition,Fg and DD.Medical staff should select appropriate catheter materialfor the patients,monitor coagulation-related factors closely,so as to reduce the risk of PICCrelated thrombosis.