長期臥床PICC置管患者上肢靜脈血栓形成危險因素分析

趙海平　　鐘玲玲

[關鍵詞] PICC置管;上肢;靜脈血栓;化療史;導管堵塞;導管相關感染;導管移位;抗凝劑

[中圖分類號] R714.6? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 1673-9701（2021）21-0038-04

Risk factors analysis of upper limb venous thrombosis in long-term bedridden patients with PICC catheterization

ZHAO Haiping? ?ZHONG Lingling

Department of General Internal Medicine， Zhejiang Tongde Provincial Hospital， Hangzhou? ?311122，China

[Abstract] Objective To explore the risk factors of upper limb venous thrombosis in long-term bedridden patients with PICC catheterization. Methods A total of 1100 patients were performed PICC in our hospital from January 2019 to October 2020. Clinical data of 80 of them were selected for retrospective analysis and divided into thrombotic group （n=22） and non-thrombotic group（n=58） according to the occurrence of upper limb venous thrombosis. The general information and clinical data of the patients were recorded， and the risk factors of upper limb venous thrombosis were analyzed. Results ①There was a higher incidence of thrombosis in patients with the following factors： Diabetes， NRS 2002≥3 points， APACHE Ⅱ≥8 points， history of PICC catheter， history of chemotherapy， catheter blockage， catheter associated infection，catheter displacement after catheterization， increased TG， TC and D-dimer. There was a lower incidence of thrombosis in patients who took anticoagulants orally. The differences were statistically significant （P<0.05）. ②Diabetes，NRS 2002≥3 points，APACHE Ⅱ≥8 points， history of PICC catheter， history of chemotherapy， catheter blockage， catheter associated infection， catheter displacement after catheterization， increased TG， TC and D-dimer were independent risk factors for upper limb venous thrombosis in long-term bedridden patients with PICC catheterization， while orally taking anticoagulants was a protective factor（P<0.05）. Conclusion Long-term bedridden patients with PICC catheterization should pay attention to prevent thrombosis. Operation specifications should be strictly followed during PICC catheterization to reduce the risk of related thrombosis.

[Key words] PICC catheter; Upper limb; Venous thrombosis; History of chemotherapy; Catheter blockage; Catheter associated infection; Catheter displacement; Anticoagulants

外周靜脈置入中心靜脈導管（Peripherally inserted central catheter，PICC）置管是通過外周靜脈血管，置入導管到達心臟附近大血管，尖端位于上腔靜脈或鎖骨下靜脈的方法，是中心靜脈輸液的有效渠道，為患者提供中長期輸液、化療、輸血等治療條件，避免各類藥物對血管內膜的刺激，確保輸液安全。導管材質為硅膠，柔軟可彎曲，彈性好，對血管刺激小。上肢靜脈血栓形成是PICC的主要并發癥之一，一旦血栓形成后上肢腫脹、疼痛等，嚴重者甚至血栓脫落導致肺栓塞，影響患者的生命[1-2]。長期臥床患者常常伴有血流動力學異常，本身更容易發生血栓形成。本研究通過回顧性分析的方法探討PICC置管患者上肢靜脈血栓形成的危險因素，以期為臨床預防提供參考，現報道如下。