| 张慧英.经外周静脉置入中心静脉导管在肿瘤患者中的应用[J].上海护理,2022,22(11): |
| 经外周静脉置入中心静脉导管在肿瘤患者中的应用 |
| Central venous catheter placement via peripheral veins in oncology patients |
| DOI： |
| 中文关键词: 中心静脉导管 感染 静脉血栓 并发症 |
| 英文关键词:PICC infection venous thrombosis complications |
| 基金项目: |
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| 中文摘要: |
| 目的 通过回顾性分析癌症患者中PICC相关的静脉血栓形成及其危险因素,估计并发症发生率,并评估对医院资源利用的影响。方法 回顾性地收集了2018年1月1日至2020年7月31日接受了至少一次静脉注射抗癌治疗,并插入了经外周静脉置入中心静脉导管的癌症患者,采用频率分析比较并发症、静脉血栓栓塞(VTE)、感染以及置换和过早拔除的发生率,采用单变量logistic回归模型对PICC相关静脉血栓形成的危险因素进行估计。结果 ①PICC研究组的中位年龄为66岁,大多数为女性(56.07%)、患有早/中期或可治愈的癌症(57.05%),常见的肿瘤是淋巴瘤(29.18%)与胃肠道癌(23.23%),并且大多数患者具有中等风险的Charlson合并症指数(48.85%)；②大多数(71.15%)的PICC置管选择右上臂,平均置管99天。PICC的早期并发症发生率为8.85%,以出血为常见的事件；晚期并发症发生率为24.26%,以导管移位为是最常见； 静脉血栓形成(VTE)事件占16.72%,其中CRT占54.90%、远处VTE占45.10%；每1000个留置日的总感染率为0.43,导管相关血流感染发生率为0.22。过早拔除PICC导管发生率为26.56%,一半以上是由于错位或机械功能障碍(占55.56%)。③早期和晚期并发症之间的临床特征(包括年龄、性别、基础疾病)没有显著差异,但在导管相关性血栓形成存在显著差异。血栓形成的发生率与年龄、性别、糖尿病或高血压或心脏病病史、置入持续时间、导管相关血流感染之间没有关系。,而高体重指数(BMI)和高甘油三酯的患者血栓形成的发生率增加。结论 肿瘤化疗PICC患者中血栓形成,随着置管时间的延长呈先高后低再缓慢升高的趋势。因此,置管后 30d内开展2-3次PICC相关深静脉血栓形成的筛查是非常必要的,可及早发现无症状血栓并采取干预措施；置管后远期应警惕导管其他并发症及治疗因素对 PICC相关深静脉血栓形成的影响。 |
| 英文摘要: |
| Objective To estimate complication rates and assess the impact on hospital resource utilization by retrospectively analyzing PICC-related venous thrombosis and its risk factors in cancer patients. Methods Cancer patients who received at least one intravenous anticancer treatment with a central venous catheter inserted via a peripheral vein from January 1, 2018, to July 31, 2020, were retrospectively collected, and the incidence of complications, venous thromboembolism (VTE), infection, and replacement and premature removal were compared using frequency analysis and univariate logistic regression models for PICC related venous thrombosis risk factors were estimated. Results ①the median age of the PICC study group was 66 years, the majority were female (56.07%), had early/intermediate or curable cancer (57.05%), the common tumors were lymphoma (29.18%) versus gastrointestinal cancer (23.23%), and the majority of patients had a moderate risk Charlson comorbidity index (48.85%); ②The majority(71.15%) of PICC placements chose the right upper arm, with a mean placement of 99 days. the early complication rate of PICC was 8.85%, with bleeding as the common event; the late complication rate was 24.26%, with catheter displacement being the most common; venous thrombosis (VTE) events accounted for 16.72%, with CRT accounting for 54.90% and distant VTE for 45.10%; the overall infection rate per 1000 indwelling days was 0.43, and the incidence of catheter-related bloodstream infection was 0.22. The incidence of premature PICC catheter removal was 26.56%, and more than half was due to misalignment or mechanical dysfunction (55.56%). ③There were no significant differences in clinical characteristics (including age, gender, and underlying disease) between early and late complications, but there were significant differences in catheter-related thrombosis. There was no relationship between the incidence of thrombosis and age, sex, history of diabetes or hypertension or cardiac disease, duration of placement, catheter-associated bloodstream infection , whereas the incidence of thrombosis was increased in patients with high body mass index (BMI) and high triglycerides. Conclusion Thrombosis in PICC patients undergoing oncologic chemotherapy tends to be higher, then lower, and then slowly higher as the duration of catheter placement increases. Therefore, screening for PICC-associated deep vein thrombosis 2-3 times within 30 d after placement is essential for early detection of asymptomatic thrombosis and intervention; the impact of other catheter complications and therapeutic factors on PICC-associated deep vein thrombosis should be monitored in the long term after placement. |
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