肝癌患者介入治疗穿刺处出血影响因素的真实世界研究

A real world study of influencing factors of bleeding at the puncture site in patients with liver cancer undergoing interventional therapy

目的探讨经股动脉介入治疗肝癌患者穿刺处出血的影响因素。方法前瞻性收集2021年7月至2023年1月于我中心收治的经股动脉介入治疗肝癌患者的临床资料。采用单因素和多因素Logistic回归分析,确定肝癌患者穿刺处出血的独立风险因素。结果共纳入936例肝癌患者进行分析,其中发生穿刺处出血109例(11.6%)。单因素分析提示性别、BMI、本次手术类型、肝功能情况、门脉高压、血小板、凝血酶原时间、纤维蛋白原、鞘管留置时间、血管穿刺次数与穿刺处出血相关(P<0.1)。多因素Logistic回归分析表明女性(OR=16.421,95%CI:8.299~32.492)、BMI≥28 kg/m2(OR=3.898,95%CI:1.489~10.202)、肝硬化Child-Pugh评分5~6分(OR=3.179,95%CI:1.754~5.761)、肝硬化Child-Pugh评分≥7分(OR=8.171,95%CI:3.656~18.264)、血小板计数50~100×10^(9)/L(OR=6.228,95%CI:3.470~11.176)、血小板计数<50×10^(9)/L(OR=77.491,95%CI:16.321~367.917)、鞘管留置时间>240 min(OR=4.060,95%CI:2.012~8.193)、血管穿刺次数=2次(OR=9.422,95%CI:4.786~18.549)、血管穿刺次数>2次(OR=28.347,95%CI:12.217~65.773)是发生穿刺处出血的危险因素。术前一周使用止血相关药物(OR=0.048,95%CI:0.015~0.151)为保护因素。结论女性、肥胖、肝硬化、血小板减少、鞘管留置时间>240 min、血管反复穿刺是发生穿刺处出血的独立危险因素。其中肝硬化Child-Pugh评分越高,血小板减少越严重,发生穿刺处出血的风险越大。

Objective To explore the influencing factors of puncture site bleeding in patients with liver cancer treated by femoral artery intervention.Methods From July 2021 to January 2023,the clinical data of patients with liver cancer treated with percutaneous femoral artery intervention in our center were prospectively collected.Univariate and multivariate logistic regression analysis was used to determine the independent risk factors for bleeding at the puncture site in patients with liver cancer.Results A total of936 patients with liver cancer were included for analysis,of which 109(11.6%)had bleeding at the puncture site.Univariate analysis showed that gender,BMI,type of surgery,liver function,portal hypertension,platelets,prothrom-bin time,fibrinogen,sheath retention time,and number of vascular punctures were associated with bleeding at the puncture site(P<0.1).Multivariate logistic regression analysis showed that female(OR=16.421,95%CI:8.299~32.492),BMI≥28 kg/m2(OR=3.898,95%CI:1.489~10.202),liver cirrhosis Child-Pugh score 5~6 points(OR=3.179,95%CI:1.754~5.761),liver cirrhosis Child-Pugh score≥7 points(OR=8.171,95%CI:3.656~18.264),platelet count 50~100×10^(9)/L(OR=6.228,95%CI:3.470~11.176),platelet count<50×10^(9)/L(OR=77.491,95%CI:16.321~367.917),sheath retention time>240 min(OR=4.060,95%CI:0.012~8.193),number of vascular punctures=2(OR=9.422,95%CI:4.786~18.549),and number of vascular punctures>2(OR=28.347,95%CI:12.217~65.773)were risk factors for bleeding at the puncture site.The use of hemostatic drugs(OR=0.048,95%CI:0.015~0.151)one week before surgery was a protective factor.Conclusions Female,obesity,liver cirrhosis,thrombocytopenia,sheath retention time>240 min,and repeated vascular puncture are independent risk factors for bleeding at the puncture site.The higher the Child-Pugh score in cirrhosis,the more severe the thrombocytopenia,and the greater the risk of bleeding at the puncture site.