肿瘤化疗患者PICC相关性上肢静脉血栓形成时间及其影响因素分析*

Analysis of the time to and influencing factors for peripherally inserted central catheter-related upper extremity venous thrombosis in patients with tumor undergoing chemotherapy*

摘要:

目的 比较肿瘤化疗患者经外周静脉穿刺的中心静脉导管（PICC）置管后不同阶段上肢静脉血栓 的临床特征，并探讨不同阶段血栓形成的影响因素。方法 采用前瞻性观察对PICC置管化疗的3 142例肿瘤患者 进行跟踪调研、比较分析。置管后1～30 d出现PICC相关性上肢静脉血栓（PICC-related UEVT）的患者为近期 血栓组（86 例），置管后31～210 d 出现PICC-related UEVT 的患者为晚期血栓组（68 例）。结果 154例发生 PICC-related UEVT，总发生率为4.90%。近期血栓组无症状血栓发生率较高（P <0.05），远期血栓组有症状血栓 发生率较高（P <0.05）。两组患者在有无临床症状方面比较，差异有统计学意义（P <0.05）；两组在血栓静脉、 血栓程度方面比较，差异无统计学意义（P >0.05）。两组在导管相关其他并发症方面比较，差异有统计学意义 （P <0.05）。两组患者在PICC置管史、穿刺部位、穿刺静脉、导管/静脉直径比、置管长度、穿刺次数、送管次数 及导管尖端位置方面比较，差异无统计学意义（P >0.05）。近期血栓组多数患者发生PICC-related UEVT距离末 次化疗时间短，远期血栓组多数患者发生PICC-related UEVT距离末次化疗时间长。两组患者在手术、促血小板 药物使用情况方面比较，差异有统计学意义（P <0.05）。两组患者在放疗、全肠外营养、输血、促红细胞生成素、 化疗药物方面比较，差异无统计学意义（P >0.05）。经抗凝、溶栓治疗后，近期血栓组静脉血栓分级情况优于远 期血栓组（P <0.05）。结论 肿瘤化疗患者PICC-related UEVT发生率随着置管时间的变化，表现出先高后低再 缓慢升高的变化趋势；置管后不同阶段发生的血栓特征及相关因素有差异，应针对差异性采取相应的干预措施， 以降低PICC-related UEVT发生率。

Abstract:

Objective To compare the clinical characteristics of the upper extremity veinous thrombosis (UEVT) and to explore the influencing factors of thrombosis in different stages after peripherally inserted central catheter (PICC) placement in patients with tumor undergoing chemotherapy. Methods We prospectively followed up 3142 patients with tumor undergoing chemotherapy treated with PICC and analyzed relevant clinical data. Patients developing PICC-related UEVT 1 to 30 days or 31 to 210 days after PICC placement were included in shortterm thrombosis group (n = 86) or long-term thrombosis group (n = 68). Results The overall incidence of PICC-related UEVT was 4.90% with a total number of 154 patients. The incidence of asymptomatic thrombosis was higher in the short-term thrombosis group, while that of symptomatic thrombosis was higher in long-term thrombosis group (P < 0.05). The clinical symptoms and other complications associated with PICC were different between the two groups (P < 0.05), but there was no difference in the vein with thrombosis, the degree of thrombosis, history of PICC, site of puncture, the vein selected for puncture, catheter diameter to vein diameter ratio, length of catheter, the number of puncture, the number of catheter placement and the position of catheter tip between the two groups (P > 0.05). The time to PICC-related UEVT from the last chemotherapy was short in short-term thrombosis group but long in long-term thrombosis group. The history of surgery and platelet-stimulating agent use were different between the two groups (P < 0.05), whereas the history of radiotherapy, total parenteral nutrition, blood transfusion, erythropoietin and chemotherapy drug use were not different between the two groups (P > 0.05). After anticoagulant and thrombolytic treatments, the venous thrombosis in short-term thrombosis group was milder than that in longterm thrombosis group (P < 0.05). Conclusions The incidence of PICC-related UEVT in patients with tumor undergoing chemotherapy shows a dynamic trend - being first high, then low and slowly on the rise - with the change of catheter placement time. The characteristics and related factors of thrombosis in distinct stages after catheter placement are different. Thus, corresponding intervention measures should be taken to reduce the incidence of PICCrelated UEVT.