PICC相关性静脉血栓在恶性肿瘤患者中相关因素分析及干预护理对策

Analysis of related factors of PICC related venous thrombosis in patients with malignant tumor and comprehensive nursing intervention

目的分析PICC相关性静脉血栓在恶性肿瘤患者中的相关因素,并提出有效综合护理干预。方法选取2016年3月-2018年4月本院住院部行PICC置管术恶性肿瘤患者216例作为调查对象,根据是否发生上肢静脉血栓分为静脉血栓组(86例)和非静脉血栓组(130例),收集两组患者临床资料并进行单因素和多因素回归分析,探讨PICC相关性静脉血栓的危险因素,针对危险因素提出护理干预对策。结果单因素分析得出,年龄、临床分期、手术史、静脉血栓形成史、用药史、化疗补液时间、置管前血浆D-二聚体水平、置管次数、穿刺方法、穿刺部位在两组患者中比较差异有统计学意义(P <0.05)。多因素分析得出,年龄≥65岁、静脉血栓形成史、未使用抗凝药物、化疗补液时间≥3d、置管前血浆D-二聚体水平>0.5 mg/L、传统穿刺、贵要静脉穿刺均为PICC相关性静脉血栓形成的危险因素。在护理满意度评分方面,干预组为95.35%,常规组为76.74%,干预组高于对照组(P<0.05)。在焦虑(SAS)评分和抑郁(SDS)评分方面,干预组评分低于常规组评分(P<0.05)。结论 PICC相关性静脉血栓在恶性肿瘤患者中的相关因素众多,对于年龄≥65岁、有静脉血栓史、置管前血浆D-二聚体>0.5 mg/L等,建议做好护理干预措施,其具有一定的临床价值,能够提高护理满意度和缓解不良情绪。

Objective To analyze the related factors of PICC-related venous thrombosis in patients with malignant tumors and to propose an effective comprehensive nursing intervention.Methods A total of 216 patients with malignant tumors with PICC were selected from March 2016 to April 2018 in our hospital.The patients were divided into the venous thrombosis group(86 cases)and the non-venous thrombosis group(130 cases)according to whether venous thrombosis occurred.The clinical data of two groups of patients were collected and univariate and multivariate regression analysis was conducted to investigate the risk factors of PICC-related venous thrombosis and put forward nursing intervention strategies for risk factors.Results Univariate analysis showed that age,clinical stage,surgical history,venous thrombosis,medication history,chemotherapy rehydration time,plasma D-dimer level before catheterization,number of catheterization,puncture method,and puncture site.There was a statistically significant difference in patients(P<0.05).Multivariate analysis showed that age over 65 years old,history of venous thrombosis,no use of anticoagulant drugs,chemotherapy rehydration time≥3 days,plasma D-dimer level before catheterization>0.5 mg/L,traditional puncture,precious vein Puncture was a risk factor for PICC-related venous thrombosis.After comprehensive nursing,the study group was 95.35%,the conventional group 76.74%,and the study group was higher than that of the control group(P<0.05).In terms of anxiety(SAS)scores and depression(SDS)scores,the study group scores were lower than that of the normal group scores(P<0.05).Conclusion There are many related factors in PICC-related venous thromboembolism in patients with malignant tumors.For age≥65 years,history of venous thromboembolism,pre-insertion plasma D-dimer>0.5 mg/L,etc.,it is recommended that nursing intervention be done.Try to avoid traditional punctures.Among them,comprehensive nursing has important clinical value,which can improve nursing satisfaction and relieve bad mood.