乳腺癌术后经外周静脉穿刺中心静脉置管侧上肢静脉血栓形成的危险因素与应对策略分析

Analysis of risk factors and coping strategies of upper limb venous thrombosis on the side of peripherally inserted central catheter after breast cancer surgery

目的探讨乳腺癌术后经外周静脉穿刺中心静脉置管(PICC)侧上肢静脉血栓形成(UEVT)的危险因素与应对策略。方法收集2020年1月至2023年1月于南京鼓楼医院集团安庆市石化医院就诊的93例乳腺癌术后PICC置管侧发生UEVT患者的临床资料,采用倾向匹配法根据患者年龄按1:2比例及是否发生UEVT将其分为UEVT组(n=31,发生UEVT)和NUEVT组(n=62,未发生UEVT),比较两组患者的年龄、体重指数、乳腺癌临床分期、分化程度、合并症、置管位置、D-二聚体(D-D)、C-反应蛋白(CRP)、低密度脂蛋白胆固醇(LDL-C)、血小板计数(PLT)等,分析乳腺癌患者术后发生UEVT的相关因素及应对策略。结果PICC置管位置、D-D、CRP、PLT均为乳腺癌术后PICC置管侧UEVT形成的危险因素(OR﹥1,P﹤0.05)。PICC肘下置管对同侧UEVT形成具有较低预警价值(AUC=0.581),D-D、CRP、PLT均具有较高预警价值(AUC=0.844、0.755、0.827),其中,预警值为D-D≥517.67 ng/ml、PLT≥376.91×10^(9)/L、CRP≥5.22 mg/L。结论乳腺癌术后PICC置管患者应及时进行D-D、CRP、PLT水平检测,若发现检测结果高于预警值时应积极进行抗凝、抗炎、抗血小板治疗,同时应尽量选取肘上穿刺置管等,能够降低患者置管侧UEVT的发生风险。

Objective To explore the risk factors and coping strategies of upper limb vein thrombosis(UEVT)on the side of peripherally inserted central catheter(PICC)in patients with breast cancer after surgery.Method Clinical data of 93 patients with UEVT on the side of PICC catheter after breast cancer surgery in Nanjing Gulou Hospital Group Anqing Petrochemical Hospital from January 2020 to January 2023 were collected.According to the proportion of 1:2 of patients'age and occurrence of UEVT,all patients were divided into the UEVT group(n=31,with NEVT)and NUEVT group(n=62,without NEVT).The age,body mass index,clinical stage of breast cancer,differentiation degree,complications,catheter location,D-dimer(D-D),C-reactive protein(CRP),low-density lipoprotein cholesterol(LDL-C),and platelet count(PLT)were compared between two groups.The related factors and countermeasures for UEVT after breast cancer surgery were analyzed.Result PICC catheterization location,D-D,CRP and PLT were all risk factors for UEVT on the side of PICC catheterization after breast cancer surgery(OR>1,P<0.05).PICC sub-elbow catheterization had a lower early warning value for ipsolateral UEVT(AUC=0.581),while D-D,CRP,and PLT had higher early warning values(AUC=0.844,0.755,and 0.827).The early warning values were D-D≥517.67 ng/ml,PLT≥376.91×10^(9)/L,and CRP≥5.22 mg/L.Conclusion For patients with PICC catheterization after breast cancer surgery,D-D,CRP and PLT levels should be detected in time.If the test results are found to be higher than the warning value,anti-coagulation,anti-inflammatory and anti-platelet therapy should be actively performed.Meanwhile,suprabecular catheterization should be selected,which can reduce the risk of UEVT in the upper limb of patients with catheterization.