血栓弹力图在预测肿瘤患者PICC相关性静脉血栓形成中的作用

Role of thrombelastogram in predicting PICC-related venous thrombosis in cancer patients

目的探讨血栓弹力图(TEG)在预测肿瘤患者经外周置入中心静脉导管(PICC)相关性静脉血栓形成中的作用。方法选取2019年1月至2022年6月在我院留置PICC的230例肿瘤患者为研究对象,随机将其分为观察组(115例)和对照组(115例)。两组研究过程中共13例患者退出,其中观察组3例,对照组10例。观察组于PICC置管前、置管1周后监测TEG,并根据TEG参数提示的凝血状态指导口服阿司匹林预防血栓治疗;对照组按常规PICC置管。两组患者分别于PICC置管后6周内每周行1次血管超声检查。比较观察组凝血正常者及高凝状态者不同时间的TEG值;比较两组患者的PICC相关性静脉血栓发生情况。结果观察组经TEG检测判断血液凝血正常者86例,血液高凝状态者26例;置管前、置管1周后,观察组凝血正常者的TEG各项指标比较,差异无统计学意义(P>0.05);干预1周后,观察组高凝状态者的TEG各项指标优于干预前(P<0.01)。观察组的PICC相关性静脉血栓总发生率低于对照组(P<0.001)。结论TEG在预测肿瘤患者PICC相关性静脉血栓形成中的效果显著。

Objective To explore the role of thrombelastogram(TEG)in the prediction of peripherally inserted central catheters(PICC)-related venous thrombosis in cancer patients.Methods From January 2019 to June 2022,230 cancer patients with PICC in our hospital were selected as the research objects,and the patients were randomly divided into observation group(115 cases)and control group(115 cases).A total of 13 patients withdrew from the two groups during the study,including 3 cases in the observation group and 10 cases in the control group.In the observation group,TEG was monitored before PICC catheterization and 1 week after catheterization,and oral aspirin was guided to prevent thrombosis according to the coagulation status indicated by TEG parameters;the control group was treated with conventional PICC catheterization.The patients in the two groups were examined by vascular ultrasound once a week within 6 weeks after PICC catheterization.The TEG values of normal coagulation and hypercoagulable state at different time in the observation group were compared;the incidence of PICC-related venous thrombosis was compared between the two groups.Results In the observation group,86 cases of normal blood coagulation and 26 cases of hypercoagulable state were judged by TEG detection;before catheterization and 1 week after catheterization,there were no significant differences in TEG indexes of patients with normal coagulation in the observation group(P>0.05);after 1 week of intervention,the TEG indexes of patients with hypercoagulable state in the observation group were better than those before intervention(P<0.01).The total incidence of PICC-related venous thrombosis in the observation group was lower than that in the control group(P<0.001).Conclusion TEG has a significant effect in predicting PICC-related venous thrombosis in cancer patients.