短期中心静脉通路在乳腺癌患者多周期化疗中的应用——单中心真实世界队列研究

Short-term central venous access in multi cycle chemotherapy of breast cancer patients:single center real world cohort study

目的 探讨短期中心静脉通路(CVA)在乳腺癌患者多周期化疗中的有效性和安全性.方法 选取439例置入CVA的乳腺癌患者,所有患者均完成4~8个周期化疗.根据置管模式的不同将患者分为经皮穿刺锁骨下静脉置入中心静脉导管(SICC)组(n=98)和经外周静脉穿刺的中心静脉导管(PICC)组(n=341).观察两组患者的临床特征、中心静脉导管特征及结局指标.结果 SICC组98例患者置入463根导管,PICC组341例患者置入344根导管.SICC组患者的年龄大于PICC组,早期置管者占比低于PICC组,合并糖尿病、既往血栓病史者占比均高于PICC组,差异均有统计学意义(P﹤0.05).SICC组以4周期化疗为主,PICC组以8周期化疗为主,但两组患者均完成了4~8周期化疗.SICC组和PICC组患者的中位置管次数分别为4次和1次,使用天数/导管分别为3天和26天.SICC组中,8例(8.2%)患者发生导管相关并发症,导管相关并发症发生率为1.96‰;PICC组中,50例(14.7%)患者发生导管相关并发症,导管相关并发症发生率为1.37‰.与PICC组相比,SICC组导管相关并发症发生风险的相对危险度(RR)为0.557(95%CI:0.273~1.134).结论 SICC与PICC在乳腺癌患者多周期化疗中具有相同的有效性和安全性,短期CVA模式SICC更适合年龄大、病情重、合并症多、无导管维护条件、预期治疗时间短的乳腺癌患者.

Objective To explore the efficacy and safety of short-term central venous access(CVA)in multi cycle chemotherapy of breast cancer patients.Method A total of 439 breast cancer patients treated with CVA were selected,all patients received 4-8 cycles of chemotherapy and were divided into subclavianly inserted central venous catheter(SICC)group(n=98)and peripherally inserted central venous catheter(PICC)group(n=341)according to method of catheter im-plantation.The clinical characteristics,characteristics of central venous catheters and prognosis were observed in two groups.Result A total of 98 patients(463 catheters)in SICC group and 341 patients(344 catheters)in PICC group were enrolled.The age of SICC group was higher than that in PICC group,the proportion of early catheter placed was lower than that in PICC group,and proportion of patients with concomitant diabetes and history of thrombus were higher than those in PICC group(P<0.05).SICC group mainly completed 4 cycles of chemotherapy,PICC group mainly completed 8 cycles of chemotherapy,and patients in both groups completed 4-8 cycles of chemotherapy.The median number of cathe-ter placement in SICC group and PICC group was 4 and 1,respectively,and the usage days of each catheter were 3 and 26 days respectively.In the SICC group,8(8.2%)patients developed catheter related complications,with the incidence of 1.96‰.In the PICC group,50(14.7%)patients developed catheter related complications,with the incidence of 1.37‰.Compared with the PICC group,the relative risk(RR)of catheter-related complications in the SICC group was 0.557(95%CI:0.273-1.134).Conclusion SICC and PICC have the same efficacy and safety in multi cycle chemotherapy of breast cancer patients.SICC with short term CVA is more suitable for breast cancer patients with older ages,serious dis-ease,more complications,no catheter maintenance conditions,and short expected treatment time.