恶性肿瘤患者深静脉导管相关血栓的风险评估及护理

Risk Assessment and Nursing Interventions of Catheter-Related Thrombosis for Malignant Tumor Patients

目的探讨恶性肿瘤患者深静脉导管相关血栓的风险因素及护理对策。方法选择2018年2月至2020年12月在我院肿瘤内科应用PICC导管化疗的恶性肿瘤患者,经血管彩超定期随访调查深静脉导管相关血栓的发生率,问卷调查一般资料并分析影响深静脉导管血栓发生危险因素。结果经超声筛查出导管相关性静脉血栓的患者22例,静脉血栓发生率约2.50%。22例患者中,左侧上臂静脉置管14例(62.0%),右侧上臂静脉置管8例(19.4%),传统方法穿刺15例(68.2%),超声引导下方法穿刺7例(31.8%),Ⅲ期及Ⅳ期患者18例(81.8%),Ⅰ期及Ⅱ期患者4例(19.2%);两组在化疗药物、置管方式、置管部位、输血史、血小板计数升高方面存在明显差异(P<0.05)上述指标是影响恶性肿瘤患者深静脉导管相关血栓的相关因素。结论行PICC治疗的恶性肿瘤患者相关血栓形成受化疗药物、置管方式、置管部位、输血史和血小板计数水平偏高等因素的影响,通过分析危险因素原因,制定出合理干预措施,能降低不良事件发生率。

Objective To discuss the risk factors and nursing measures of catheter-related thrombosis for malignant tumor patients.Methods Malignant tumor patients of undergoing the chemotherapy via PICC(peripherally inserted central catheter)from February 2018 to December 2020 in our medical oncology department were selected.Color Doppler ultrasound was applied to measure the occurrences of catheter-related thrombosis.Patient’s general data was acquired.Through the multivariate Logistic regression equation,the risk factors of catheter-related thrombosis were analyzed.Results According to ultrasonic screening,22 patients were found with catheter-related thrombosis(2.50%),including 14 cases in the left upper arm(62.0%)and 8 cases in the right upper arm(19.4%).15 patients were punctured in the conventional way(68.2%)and 7 cases under the ultrasonic guidance(31.8%).18 patients of phaseⅢand phaseⅣwere discovered(81.8%),4 patients of phaseⅠand phaseⅡ(19.2%);the chemotherapy drugs,catheterization modes,catheterization positions,transfusion history and increased platelet count between groups were found to be statistically significant(P<0.05);Logistic regression equation indicated that the risk factors of catheter-related thrombosis included the chemotherapy drugs,catheterization modes,catheterization positions,transfusion history and increased platelet count.Conclusion The influence factors of catheter-related thrombosis are chemotherapy drugs,catheterization modes,catheterization positions,transfusion history and increased platelet count.Therefore,the specific interventions can ensure the treatment effects of malignant tumor patients.