Viabahn Stent Graft for Inadvertent Insertion of a Central Venous Catheter in the Subclavian Artery

Subclavian artery (SCA) injuries associated with central venous catheter (CVC) insertion are uncommon yet lethal complications that typically require surgical treatment. This case report presents the case of a 94-year-old man with an iatrogenic right SCA injury resulting from a misplaced CVC. Computed tomography revealed the catheter piercing the right internal jugular vein to enter the right SCA and then reaching the aortic arch. Emergent endovascular treatment was performed, and a 13-mm × 50-mm self-expanding Viabahn stent graft (W.L. Gore & Associates, Flagstaff, AZ, USA) was placed via the right brachial artery. The misplaced catheter was successfully removed under simultaneous postdeployment balloon dilatation. This case highlights the utility of the Viabahn stent graft for iatrogenic right SCA injury caused by a misplaced CVC and presents some insights and tips for a safer procedure.

Analysis of Use and Outcomes of Peripherally Inserted Central Catheter (PICC-Line) in Hemato-Oncological Patients

Aims: To audit the use and outcomes of using PICC lines in hemato-oncological patients. Objectives: To study the demographics of patients: ?studying the use of PICC line in hemato-oncological patients;studying the rate of complications in PICC line;studying the cause of early removal of PICC line. Methods: All PICCs inserted in adult hemato-oncological patients in Hematology and Medical Oncology Department of Health Care Global (HCG) Hospital were studied prospectively, as per the proforma, till PICCs were removed or patient expired and the pattern of complications were noted. Results: Eighty-four PICCs were inserted over a period of initial nine months and followed for a total of 1 year with three months post insertion duration for a total of 10,868 catheter-days (mean of 129 days i.e. 4.3 months, range: 1 to 288 days). The most common indication for PICC was chemotherapy (100%). Among them 19 (22%) PICCs had complications and 12 were removed at the rate of 1.1/1000 PICC-days. Complications with haematologic malignancies were more as compared to those with solid tissue malignancies. Conclusions: Despite significant complication rates, PICCs are a relatively safe and cost effective mode of establishing central venous access.

Focus on peripherally inserted central catheters in critically ill patients

Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care.

Clinical Application of Newborn Umbilical Vein Catheterization Combining with PICC

Purpose: Research on clinical application effect of combining very low birth weight newborn (VLBWN) umbilical vein catheterization (UVC) with peripherally inserted central catheter (PICC). Method: 60 cases of VLBWN checked in our hospital’s ICU are selected and divided into combination group (n = 30) and PICC group (n = 30) according to the random number table. Combination of UVC and PICC is applied on newborn of combination group while only PICC is applied on newborn of PICC group. These two groups’ newborn’s PICC catheterization operation time, PICC indwelling time, weight gain, hospital stays, hospital infection, planned extubation, successful single puncture, adverse events and other indexes are observed. Result: Newborns in combination group have less PICC catheterization operation time and less hospital stays than newborns in PICC group while newborns in combination group have longer PICC indwelling time and greater weight gain than newborns in PICC group. The difference here has statistical significance (p < 0.05). Combination group’s hospital infection ratio (3.33%) is lower than that of PICC group (23.33%). The difference here has statistical significance (p < 0.05). Newborns in combination group have a planned extubation rate of 93.33% and a successful single puncture rate of 93.33%, which are greater than those of newborn in PICC group (respectively 73.33% and 70.00%). The difference here has statistical significance (p < 0.05). Newborns in combination group have an adverse event occurrence rate of 43.33%, lower than that of PICC group (70.00%). The difference here has statistical significance (p < 0.05). Conclusion: Application of combination of UVC and PICC on VLBWN can greatly improve PICC catheterization efficiency and newborn patients’ nutriture and reduce rate of complications, thus, it is worthy of clinical application.

Economic Analysis of Port and PICC in Long-term Intravenous Administration for Malignant Tumor Patients in Chinese Oncology Hospital Setting

OBJECTIVE: To calculate and compare the cost of Port and PICC's application in long-term intravenous administration, and to support the decision making of hospital manager. METHODS: Literature review and patient survey in 2 oncology centers in China were carried out to investigate the cost and impact of Port and PICC for patients. The cost at different time of intravenous administration was calculated and compared. One-way sensitivity analysis was performed and tornado graph was drawn. RESULTS: Direct cost of Port at 0.5, 1, 1.5, and 2 years were7442, 8005, 8553, and 9131 CNY, and 4700, 9399, 14032, 18799 CNY for PICC respectively. Direct & indirect cost at 0.5, 1, 1.5, and 2 years were 9291, 11704, 14101, 16529 CNY for Port and 9697, 19393, 29023, 38787 CNY for PICC. Sensitivity analysis showed that productivity loss and device maintenance cost were the most in?uential factors to the result. CONCLUSION: Port had higher cost in short term and less in long term compared with PICC. Patients expected to get intravenous administration more than 0.5 year should use Port if both direct and indirect costs were included.

Clinical Study of Aspirin in the Prevention of Thrombosis in Breast Cancer Patients with Postoperative Chemotherapy after PICC Insertion

Objective: To study the clinical effect of aspirin in the prevention of venous thrombosis in breast cancer patients with postoperative chemotherapy after peripherally inserted central catheter (PICC) insertion. Methods: 240 cases of female breast cancer patients with postoperative chemotherapy after PICC insertion in The First People’s Hospital of Jingzhou from June 2014 to December 2017 were selected and divided into experimental group (n = 120) and control group (n = 120) according to the length of stay. The modified Seldinger technique was used in both groups. The experimental group had oral Aspirin enteric-coated tablet on the day of PICC insertion, 100 mg/day until the PICC catheter was removed, while the control group did not take anticoagulant drugs. The therapeutic effects were evaluated by color Doppler ultrasound, Coagulation analysis, and complete blood count. Results: There were three cases with venous thrombosis in the experimental group, and the incidence rate was 2.5%, while ten cases in the control group developed venous thrombosis, and the incidence rate was 10%. There was a statistically significant difference in the incidence of thrombosis between the two groups (P Conclusion: This study showed that oral Aspirin can effectively reduce the incidence rate of venous thrombosis in breast cancer patients with postoperative chemotherapy after PICC insertion. Therefore, it is worthy of clinical application.

多学科协作风险管控预防肿瘤病人PICC相关性静脉血栓的效果观察

目的:探讨多学科协作(MDT)风险管控预防肿瘤病人经外周静脉置入中心静脉导管(PICC)相关性静脉血栓的效果。方法:选取2020年6月—2022年6月在本院留置PICC的肿瘤病人190例,采用随机数字表法分为观察组和对照组,各95例。对照组给予常规护理,观察组在对照组基础上给予MDT风险管控护理,比较两组PICC穿刺、维护质量、相关性静脉血栓及腋下静脉最大血流速度(Vmax),平均血流速度(Vmean)情况。结果:观察组PICC一次穿刺成功率、维护质量优良率高于对照组(P<0.05);两组护理后腋下静脉Vmax、Vmean快于护理前,观察组护理后腋下静脉Vmax、Vmean快于对照组(P<0.05);观察组PICC相关性静脉血栓发生率为2.11%,低于对照组的11.58%(P<0.05)。结论:MDT风险管控可提高肿瘤病人PICC穿刺、维护质量,改善腋下静脉循环,有利于改善PICC相关性静脉血栓的预防效果。

PICC带管出院患者导管居家维护模式的可行性研究分析

目的 观察PICC带管出院患者导管居家维护模式的可行性。方法 将我院2021年1月至2022年12月收治的60例PICC带管肿瘤患者随机分为观察组30例,对照组30例。对照组(n=30)给予常规返院导管维护,观察组(n=30)给予导管居家维护,对比两组的单次维护费用及时间、平均留置时间、导管相关并发症发生情况及维护依存性。结果 观察组单次维护费用为(58.17±5.64)元,低于对照组的(132.78±9.85)元,两组单次维护费用比较,差异具有统计学意义(t=-36.004,P=0.000);观察组单次维护时间(81.13±7.62)min,较对照组的(203.34±15.67)min更短,差异具有统计学意义(t=-38.416,P=0.000)。观察组PICC平均留置时间为(141.82±13.56)d,对照组PICC平均留置时间为(137.43±14.08)d,两组PICC平均留置时间比较,差异未见统计学意义(t=1.230,P=0.224)。观察组导管相关并发症发生率36.67%,对照组26.67%,两组导管相关并发症比较,差异没有统计学意义﹙χ^(2)=0.693,P=0.405﹚。观察组能按时进行PICC导管维护者为28例,按时维护依存率为93.33%,高于对照组的70.00%,差异存在统计学意义﹙χ^(2)=5.455,P=0.020﹚。结论 PICC带管出院患者导管居家维护模式具有一定可行性,在不增加导管相关并发症及延长留置时间的前提下,可以有效地减少维护费用、缩短维护时间,提高患者维护依存性。

基于决策树法预测肿瘤患者PICC置管后上肢静脉血栓风险研究

目的探讨决策树模型对肿瘤患者PICC置管后预测血栓风险的应用价值。方法回顾性分析178例肿瘤PICC置管患者临床资料,采用CHAID决策树分析构建PICC置管后上肢静脉血栓风险因素决策树模型,并验证模型效应。结果决策树生长4层,共9个生长节点,终末节点5个,筛选出4类血栓高危人群:未使用抗凝剂的肿瘤患者;未使用抗凝剂,合并甘油三酯高于正常的患者;未使用抗凝剂,甘油三酯正常或偏低,但NRS2002营养评分≥3分的患者;未使用抗凝剂,甘油三酯正常或偏低,NRS2002营养评分<3分,无手术史。决策树模型ROC曲线下面积为0.909,敏感度87.32%,特异度96.23%。结论决策树模型对预测肿瘤患者PICC置管后上肢静脉血栓形成风险简便易行,可用于上肢静脉血栓风险高危人群的筛选。

早产儿PICC置管改良版体外预测量技术的应用与研究

目的 探讨改良版体外预测量方法应用在早产儿经外周置入中心静脉导管(PICC)置管中的可行性。方法选取2018年12月1日至2022年8月31日在首都儿科研究所附属儿童医院行PICC治疗的早产儿95例作为研究对象,按随机数字表法分为对照组47例(采用标准的体外预测量方法 )和试验组48例(采用改良版体外预测量方法 ),比较2组PICC尖端一次性到位率、导管置入长度和留置时间。结果 试验组PICC尖端一次到位率为87.5%,显著优于对照组的59.57%,差异有统计学意义(P <0.05)。试验组与对照组在导管置入长度和留置时间方面差异无统计学意义(P> 0.05)。结论 改良版体外预测量方法与理想置管深度更符合,出现偏差率低,且测量更简便,易操作。

植入式静脉输液港与PICC在血液肿瘤患者中的临床价值

目的 比较植入式静脉输液港(VPA)与经外周静脉穿刺置入中心静脉导管(PICC)在血液肿瘤患者护理中的临床应用价值,为临床血液肿瘤患者化疗期间选用合适的中心静脉给药方法提供参考。方法 选取河北工程大学附属医院2021年3月至2023年2月就诊的血液肿瘤患者80例,根据置管方法不同随机分为VPA组38例和PICC组42例,比较2组并发症、舒适度、生活质量评分。结果 VPA组并发症发生率5.26%,低于PICC组的26.19%,VPA组未发现导管阻塞、血流感染、皮肤过敏等并发症,2组差异有统计学意义(P<0.05);生活质量6个维度的比较中,1个社会关系功能无差异,其余5个VPA组均高于PICC组,2组生活质量评分比较差异有统计学意义(P<0.05);VPA组舒适度更高(P<0.05)。结论 相比于PICC静脉给药方法,VPA并发症少,舒适度好,更能提高患者生活质量,满足血液肿瘤患者长期治疗需求,值得临床推广。

PICC病人医用粘胶相关性皮肤损伤预防的最佳证据总结

目的:总结经外周静脉置入中心静脉导管(PICC)置管病人医用粘胶相关性皮肤损伤(MARSI)的相关证据,为临床循证实践提供依据。方法:应用循证的方法,根据金字塔“6S”证据模型系统检索关于预防PICC病人MARSI的相关文献。检索时限为2010年1月1日—2023年1月30日,由2名研究者对证据进行质量评价和推荐级别的评定。结果:共纳入12篇高质量文献,提取到19条最佳证据,包含对病人评估、操作方法、敷料的选择及使用、培训与教育4个方面的内容。结论:总结了预防PICC置管病人MARSI的最佳证据,为医护人员在临床工作中预防提供循证依据。

以危机预防理论为指导的新生儿PICC置管风险管理方案的构建及应用

目的构建以危机预防理论为指导的新生儿经外周静脉穿刺的中心静脉导管(PICC)置管风险管理方案,并探讨其应用效果。方法前瞻性选取郑州大学第一附属医院新生儿重症医学科2021年3月至2022年2月收治的66例拟行PICC置管的新生儿为对象,按照收治时间顺序分为对照组和观察组,各33例。对照组患儿接受常规护理干预,观察组患儿在对照组基础上接受以危机预防理论为指导的风险管理干预措施。对比两组患儿PICC置管1个月内风险事件(导管堵塞、液体外渗、皮下血肿、感染)发生情况。对比穿刺时疼痛情况[新生儿急性疼痛行为评分量表(NIAPAS)及脸、腿、活动、哭闹、安抚评估量表(FLACC)]。结果观察组风险事件总发生率低于对照组(P<0.05)。观察组穿刺时NIAPAS、FLACC评分均低于对照组(P<0.05)。结论以危机预防理论为指导的风险管理干预措施可减轻新生儿PICC置管穿刺痛感,降低置管后风险事件发生率。

1例双侧乳腺癌不同术式后保留PICC患者的护理

总结1例行左侧乳腺癌改良根治术、右侧乳房重建术患者成功保留患肢PICC的护理经验。护理重点包括术前多学科评估保留PICC的利弊,制定和实施周密的综合护理方案;加强对症管理、康复锻炼,加强营养支持及心理康复;强化延续护理。结果患者术后住院18 d,切口愈合好,携带PICC出院。出院后继续相关治疗至治疗结束拔除PICC,共留置338 d(入院前留置128 d,住院期间留置85 d,出院后留置125 d),未发生PICC相关并发症。

基于肿瘤病人PICC导管相关血栓形成影响因素的预见性护理应用效果

目的:观察以肿瘤病人PICC导管相关血栓形成影响因素的Logistic回归模型为基础的预见性护理对预防肿瘤科病人经外周静脉穿刺中心静脉置管(PICC)导管相关血栓形成的效果。方法:随机选择2021年7月—2022年6月和2022年7月—2023年6月于我院肿瘤科进行PICC置管的化疗病人分别为对照组和预见性护理组,对对照组病人给予常规护理并行Logistic多因素回归分析,总结PICC导管相关血栓形成的风险因素,对照组病人予以常规护理,预见性护理组采用以对照组Logistic多因素回归模型为基础的预见性护理。比较两组病人血栓发生率和护理满意度。结果:肿瘤分期、血栓史、是否合并糖尿病、导管末端位置以及D-二聚体水平是肿瘤科病人PICC导管相关血栓形成的危险因素,抗凝药物的使用是保护性因素。预见性护理组4.17%发生PICC置管相关血栓,明显低于对照组(30.83%);预见性护理组病人护理满意度(98.33%)高于对照组(90.83%),差异均有统计学意义(P<0.05)。结论:肿瘤分期、血栓史、是否合并糖尿病、导管末端位置以及D-二聚体水平是肿瘤科病人PICC导管相关血栓形成的危险因素,使用抗凝药物是保护性因素。以Logistic回归分析结果为基础的预见性护理不仅能够降低病人血栓的发病率,同时能够提升病人对护理工作的满意度。

留置PICC老年患者握拳运动依从性及影响因素分析

目的调查留置外周中心静脉导管(PICC)的老年患者握拳运动依从性的现状,并分析其影响因素。方法选取120例留置PICC的老年患者作为研究对象,采用握拳运动认知量表、握拳运动依从性量表、PICC相关性血栓认知量表对研究对象进行调查;采用多因素Logistic回归模型分析留置PICC的老年患者握拳运动依从性的影响因素。结果120例老年患者握拳运动认知量表总分为(15.65±7.01)分,握拳运动依从性量表总分为(8.79±3.00)分,PICC相关性血栓认知量表总分为(46.43±19.62)分,上述量表总分均处于中低水平。多因素Logistic回归分析结果显示,置管天数、握拳运动认知量表总分、PICC相关性血栓认知量表总分是留置PICC的老年患者握拳运动依从性的影响因素(P<0.05)。结论留置PICC的老年患者握拳运动依从性较低,置管天数、握拳运动认知情况、PICC相关性血栓认知情况是留置PICC的老年患者握拳运动依从性的影响因素。

肺癌化疗病人发生PICC相关上肢静脉血栓风险Nomogram模型的构建

目的:探究肺癌化疗病人发生经外周静脉置入中心静脉导管(PICC)相关上肢静脉血栓的危险因素,构建其风险Nomogram模型,并进一步验证该模型的预测价值。方法:回顾性分析2014年1月—2020年12月南昌大学第一附属医院呼吸内科收治的391例原发性肺癌化疗病人,比较病人的临床资料,并采用多因素Logistic回归模型分析肺癌化疗病人发生PICC相关上肢静脉血栓的独立危险因素,R软件整合独立危险因素并构建Nomogram模型。结果:89例(22.76%)肺癌化疗病人出现PICC相关上肢静脉血栓。体质指数(≥27.49 kg/m^(2))、糖尿病(是)、纤维蛋白原(FIB)(≥3.60 g/L)、活化部分凝血活酶时间(APTT)(≥33 s)、D-二聚体(≥0.90 mg/L)以及C反应蛋白(CRP)(≥5.80 mg/L)是肺癌化疗病人发生PICC相关上肢静脉血栓的独立危险因素(P<0.05)。该Nomogram模型预测与实际观测结果的吻合度较好,一致性指数(C-index)为0.832[95%CI(0.793,0.866)],当高风险阈值>0.05时,此Nomogram模型在预测肺癌化疗病人PICC相关上肢静脉血栓高风险的方面可提供高于单个独立危险因素的额外临床净收益。结论:基于体质指数、糖尿病、纤维蛋白原、活化部分凝血活酶时间、D-二聚体以及C反应蛋白独立危险因素构建的Nomogram模型在预测肺癌化疗病人发生PICC相关上肢静脉血栓具备可行性,可为临床风险分层及制定护理策略提供重要参考。

PICC相关新生儿胸腔积液2例并文献复习

目的探讨新生儿经外周静脉置入中心静脉导管(PICC)并发胸腔积液的临床特点、病因及防治措施,为临床诊治PICC相关新生儿胸腔积液提供依据。方法回顾2例新生儿PICC置管并发胸腔积液的临床资料,并以关键词“经外周静脉置入中心静脉导管”“胸腔积液”“PICC并发症”“peripherally inserted central catheter”“neonatal”“pleural effusion”“PICC complications”搜索中国知网(CNKI)、中华医学期刊全文数据库、PubMed、Web of science、Embase等数据库,检索2010年1月至2023年6月收录的文献。总结新生儿PICC相关胸腔积液的临床特点、治疗及预后。结果2例患儿均在PICC置管情况下突发呼吸困难,影像学检查及胸腔穿刺证实为PICC导管渗出性胸腔积液发生,通过立即拔除PICC导管以及行胸腔穿刺,胸腔积液吸收,经积极治疗后均治愈出院,预后良好。纳入文献16篇,总计53例患儿进行分析。53例患儿均为早产儿,除1例出生体重不详外,其余52例患儿均为低出生体重儿,其中极低出生体重儿44例,比例约80.2%,超低出生体重儿占比约11.3%。除1例未具体说明置管穿刺点外,其余52例患儿中,选择经上肢静脉置比例94.2%,下肢为3.8%。除8例未具体说明导管尖端位置外,其余病例中80%发生异位,以远心端方向异位居多,占比77.8%。结论新生儿PICC可并发胸腔积液,临床需引起重视并及时防范,正确处理,一般预后良好。

Padua量表在干预PICC导管相关性静脉血栓中的应用和研究

目的研究血栓风险评估(Padua)量表运用于经外周置入中心静脉导管(PICC)导管相关性静脉血栓中的评估价值。方法选择2021年6月-2022年6月期间在我院PICC专科门诊接受置管和导管维护的82例肿瘤患者为研究对象,通过随机列表法分为41例对照组与41例观察组,其中对照组在PICC置管前给予常规评估,而观察组在对照组的基础上使用Padua量表对患者进行综合全面的评估,对比两组并发症、PICC导管相关性静脉血栓的发生率、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、满意度、医疗费用、下床活动及住院时长。结果观察组PICC导管相关性静脉血栓的发生率4.88%低于对照组19.51%(P<0.05)。两组干预前的凝血指标并无差别(P>0.05),干预后观察组PT、APTT、TT均低于对照组,但FIB高于对照组(P<0.05)。观察组并发症9.76%少于对照组29.27%(P<0.05)。观察组在风险评估、护理服务、预防措施、操作专业性上的满意度高出对照组(P<0.05)。观察组医疗费用、下床活动及住院时长均少于对照组(P<0.05)。结论Padua量表在评估PICC导管相关性静脉血栓中效果显著,可有效改善患者凝血功能,减少并发症及PICC导管相关性静脉血栓的发生率,同时缩短住院时长,降低医疗费用,患者满意度高,值得推广。

乳腺癌PICC置管病人舒适度的现状调查及影响因素研究

目的:调查乳腺癌经外周静脉置入中心静脉导管(PICC)置管病人舒适度现状和影响因素,为制订乳腺癌PICC置管病人舒适护理方案提供参考。方法:采用便利抽样法于2022年5月—2023年5月选取锦州市某三级甲等医院肿瘤病区进行化疗的268例乳腺癌PICC置管病人作为调查对象,采用一般资料调查表、PICC置管病人置管后舒适度量表、肿瘤病人PICC自我管理能力量表、焦虑自评量表、抑郁自评量表和社会支持量表对其进行问卷调查。结果:乳腺癌PICC置管病人置管后舒适度得分为(43.82±7.05)分。单因素分析结果显示,不同乳腺癌分期、截至目前置管时间、是否有导管相关并发症的乳腺癌PICC置管病人置管后舒适度得分比较差异有统计学意义(P<0.05)。多元逐步回归分析结果显示,截至目前置管时间、是否有导管相关并发症、PICC自我管理能力、焦虑和社会支持是乳腺癌PICC置管病人置管后舒适度的主要影响因素(P<0.05),可解释总变异的79.6%。结论:乳腺癌PICC置管病人置管后舒适度得分处于中等水平,医护人员应关注其影响因素,并采取针对性干预措施。