食管癌放疗患者经外周静脉穿刺的中心静脉导管相关静脉血栓形成的危险因素分析

Risk factors of venous thrombosis related to peripherally inserted central venous catheter in patients undergoing esophageal cancer radiotherapy

目的探讨食管癌放疗患者经外周静脉穿刺的中心静脉导管(PICC)相关静脉血栓形成的危险因素。方法收集298例接受PICC置管的食管癌放疗患者的临床资料,根据静脉血栓的发生情况分为血栓组(108例)及无血栓组(190例)。采用多因素Logistic回归模型分析PICC相关静脉血栓形成的独立影响因素。结果298例患者中,同步放化疗患者180例(60.4%),单纯放疗患者118例(39.6%)。发生PICC相关静脉血栓108例(36.2%),其中症状血栓26例(8.7%),无症状血栓82例(27.5%)。单因素分析结果显示,血栓组中具有高脂血症史、置管长度﹤45 cm、同步放化疗、血管超声检查次数≥3次的患者比例均高于无血栓组,差异均有统计学意义(P﹤0.05)。多因素Logistic回归分析结果显示,同步放化疗是食管癌放疗患者PICC相关静脉血栓形成的独立危险因素(P﹤0.01)。结论同步放化疗可能增加食管癌患者PICC相关静脉血栓的发生风险,加强血管超声检查有利于PICC相关静脉血栓的监测及诊断,有助于及时进行抗栓治疗和疗效评价。

Objective To evaluate the risk factors of venous thrombosis related to peripherally inserted central venous catheter(PICC)in patients undergoing esophageal cancer radiotherapy.Method The clinical data of 298 esophageal cancer patients undergoing radiotherapy and PICC were collected,and the patients were divided into the thrombosis group(n=108)and non-thrombosis group(n=190).The Logistic regression analysis were used to evaluate the independent influencing factors of venous thrombosis related to PICC.Result Among 298 patients,180 cases(60.4%)were treated by concurrent chemoradiotherapy and 118 cases(39.6%)by radiotherapy alone.PICC related venous thrombosis occurred in 108 cases(36.2%),symptomatic thrombosis in 26 cases(8.7%)and asymptomatic thrombosis in 82 cases(27.5%).Univariate analysis showed that the proportion of patients with hyperlipidemia history,catheter length<45 cm,concurrent chemoradiotherapy,and vascular ultrasonography examination≥3 times in thrombosis group were higher than those in the non-thrombosis group(P<0.05).Multivariate Logistic regression analysis showed that concurrent chemoradiotherapy was independent risk factor for venous thrombosis related to PICC in patients with esophageal cancer undergoing radiotherapy(P<0.01).Conclusion Concurrent chemoradiotherapy may increase the risk of PICC related venous thrombosis in patients with esophageal cancer.Strengthening vascular ultrasonography examination is conducive to monitoring PICC related venous thrombosis and evaluating the efficacy of antithrombotic therapy.