恶性肿瘤患者中等长度静脉置管相关性血栓形成状况影响因素分析

Analysis of the formation of medium length venous catheter-related thrombosis and its influencing factors in patients with malignant tumors

目的 统计117例恶性肿瘤患者中等长度静脉置管相关性血栓(CRT)形成状况,并分析其影响因素。方法 回顾性选取首都医科大学附属潞河医院2021年1月至2023年6月收治的117例接受中等长度静脉置管的恶性肿瘤患者病历资料进行研究,根据CRT发生情况,将17例(14.53%)发生CRT患者病历资料归入发生组,其余100例(85.47%)患者病历资料归入未发生组。比较2组基线资料及实验室检测资料,通过单因素和多因素分析探讨影响恶性肿瘤患者中等长度静脉置管后CRT形成的因素。依据临床分期、合并基础疾病、置管时间、DD水平构建中等长度静脉置管的恶性肿瘤患者中发生CRT的列线图模型,采用Bootstrap内部验证法验证预测模型的区分度,C-index=0.935,提示该预测模型区分度良好;绘制标准曲线,可见校准曲线和Y-X直线相近,提示该预测模型准确度良好。以高风险阈值为横坐标,以净收益率为纵坐标绘制决策曲线,结果显示,相较于各指标单独应用,列线图模型辅助绘制的决策曲线净受益率更高,当阈值在0.02~1.00内的净受益率>0,最大净受益率为0.145,提示上述列线图模型预测中等长度静脉置管的恶性肿瘤患者中发生CRT具有良好的精准度。结果 发生组临床分期为Ⅲ~Ⅳ期的患者占比显著高于未发生组患者(P<0.05);发生组合并基础疾病个数、置管时间、D-二聚体(DD)水平显著高于未发生组,差异有统计学意义(P<0.05)。经Logistic回归分析结果显示,临床分期高、合并基础疾病个数多、置管时间长、DD水平高是117例恶性肿瘤患者中等长度静脉置管后CRT形成的危险因素(OR>1,P<0.05)。结论 117例接受中等长度静脉置管的恶性肿瘤患者中发生CRT 17例(14.53%),临床分期高、合并基础疾病个数多、置管时间长、DD水平高是影响CRT发生的危险因素,基于上述危险因素构建的预测模型可良好预测中等长度静脉置管的恶性肿瘤患者中发生风险。

Objective To investigate the formation of medium length venous catheter-related thrombosis(CRT)in 117 patients with malignant tumors and to analyze its influencing factors.Methods A retrospective study was conducted on the medical records of 117 malignant tumor patients who underwent medium length venous catheterization in Beijing Luhe Hospital,Capital Medical University from January 2021 to June 2023.According to the incidence of CRT,17 patients(14.53%)with CRT were classified as the occurrence group,while the other 100 patients(85.47%)were classified as the non-occurrence group.The baseline data and laboratory data of the two groups were compared,and the factors affecting the formation of CRT after medium-length venous catheterization in patients with malignant tumors were analyzed by univariate and multivariate analysis.Results The proportion of clinical stagesⅢ-Ⅳin the occurrence group was significantly higher than that in the non-occurrence group(P<0.05).The number of combined underlying diseases,catheterization time,and D-dimer(DD)levels were significantly higher in the occurrence group than those in the non-occurrence group(P<0.05).Logistic regression analysis showed that high clinical staging,multiple comorbidities,long catheterization time,and high DD levels were risk factors for CRT after medium length venous catheterization in 117 malignant tumor patients(OR>1,P<0.05).Conclusion Among 117 malignant tumor patients who received medium length venous catheterization,17(14.53%)developed CRT.High clinical staging,multiple comorbidities,large number of underlying diseases,long catheterization time and high DD level were risk factors for CRT.The nomogram created based on the above risk factors can well predict the risk of CRT in patients with malignant tumors with medium length venous catheterization.