手臂锻炼预防食管癌化疗患者PICC相关性血栓的效果及其对腋静脉血流速度及肩关节功能的影响

Effects of arm exercise on prevention of PICC-associated thrombus in patients with esophageal cancer undergoing chemotherapy and its effect on axillary vein flow velocity and shoulder joint function

目的:研究手臂锻炼对经外周置入中心静脉导管(Peripherally inserted central catheter,PICC)置管的食管癌化疗患者腋静脉血流速度及肩关节功能的影响。方法:选取河南科技大学第一附属医院2021年4月至2022年11月期间96例PICC置管的食管癌化疗患者随机分组(n=48),对照组给予握球锻炼,观察组联合手臂锻炼,4 w后,采用彩色多普勒超声仪测量并记录两组患者干预前后腋静脉单位时间平均血流速度(Mean flow velocity per unit time,TMFV)、最大血流速度(Maximum blood flow velocity,V_(max))水平;采用肘关节功能量表评估患者肘关节功能;采用Constant-murley肩关节评分评估两组患者肩关节功能;采用生活质量量表(Short Form 36-item Health Survey,SF-36)评估两组患者生活质量;记录机械性静脉炎、肢体肿胀、PICC相关性血栓(Peripherally inserted central catheter related venous thrombus,PICC-related VT)、PICC导管脱出等并发症发生情况。结果:与干预前相比,对照组TMFV、V_(max)水平均降低(P<0.05),观察组V_(max)、TMFV水平变化,差异无统计学意义(P>0.05),且观察组V_(max)、TMFV水平均高于对照组(P<0.05);与干预前相比,各组肘关节运动功能、日常活动、疼痛程度评分、肩关节肌力、肩关节活动度、日常活动水平、疼痛程度评分、SF-36评分均升高,其中观察组更为显著(P<0.05);干预4 w内,两组患者机械性静脉炎、肢体肿胀、PICC导管脱出发生率比较,差异无统计学意义(P>0.05);观察组PICC-related VT发生率低于对照组(P<0.05)。结论:手臂锻炼能够有效提高PICC置管的食管癌化疗患者腋静脉血流速度,改善肩关节和肘关节功能,降低PICC-related VT发生率,提高生活质量。

Objective:To investigate the effects of arm exercise on axillary vein blood flow velocity and shoulder joint function in patients undergoing chemotherapy for esophageal cancer undergoing Peripherally inserted central catheter(PICC).Method:A total of 96 patients with PICC catheterization and chemotherapy for esophageal cancer were randomly assigned to the First Affiliated Hospital of Henan University of Science and Technology from April 2021 to November 2022(n=48).The control group was given ball holding exercise and the observation group was combined with arm exercise.Four weeks later,the Mean flow velocity per unit time(TMFV)and Maximum blood flow velocity(V_(max))of the axillary vein before and after intervention were measured and recorded by color Doppler ultrasound.The elbow joint function scale was used to evaluate elbow joint function.Constant-Murley shoulder joint score was used to evaluate shoulder joint function in both groups.The Short Form 36-item Health Survey(SF-36)was used to evaluate the quality of life of patients in the two groups.Mechanical phlebitis,limb swelling,peripherally inserted central catheter-related thrombus(PICC-related VT),PICC catheter protrusion,and other complications were recorded.Results:Compared with before intervention,the levels of TMFV and V_(max)in the control group were decreased(P<0.05),while the levels of V_(max)and TMFV in the observation group were not statistically significant(P>0.05),and the levels of V_(max)and TMFV in the observation group were higher than those in the control group(P<0.05).Compared with before the intervention,elbow motor function,daily activities,pain score,shoulder muscle strength,shoulder range of motion,daily activity level,pain score,and SF-36 score were increased in all groups,and the observation group was more significant(P<0.05).Within 4 weeks of intervention,the two groups had no significant difference in the incidence of mechanical phlebitis,limb swelling,and PICC catheter prolapse(P>0.05).The incidence of PICC-related VT in the observation group was lower than that in the control group(P<0.05).Conclusion:Arm exercise can effectively improve axillary vein blood flow velocity,improve shoulder and elbow joint function,reduce the incidence of PICC-related VT,and improve quality of life in patients with esophageal cancer chemotherapy with PICC catheterization.