乳腺癌化疗患者外周置人中心静脉导管相关上肢静脉血栓形成的临床诊疗

摘要

Objective To summarize our experiences in the diagnosis and treatment of peripherally inserted central venous catheter (PICC)-associated symptomatic upper extremity vein thrombosis (UEVT) in breast cancer patients undergoing chemotherapy.Methods A retrospective study of 938 breast cancer patients with PICC from 2011 to 2012 in Peking Union Medical College Hospital were performed.The diagnosis and treatment of PICC-related symptomatic UEVT was analyzed.Results Ten patients (1.1％) developed PICCassociated symptomatic UEVT in 23.5 (4 ～ 176) days after catheter placement,for a total of 1035 catheterdays,with an incidence of 0.11 per 1000 catheter-days.Nine patients were treated with low-molecular-weight heparin for 14 (3 ～50) days,and 5 of them used catheter during anticoagulant therapy without PICC removal.No pulmonary embolus was noted in any patient.Conclusions The incidence of PICC-associated symptomatic UEVT is relatively low.Early diagnosis and treatment can achieve a good clinical outcome in these patients.%目的 探讨乳腺癌化疗患者外周置人中心静脉导管(PICC)相关上肢静脉血栓形成的临床诊疗.方法 回顾性分析北京协和医院201 1至2012年938例乳腺癌化疗患者中,PICC相关有症状上肢静脉血栓形成的发生率、诊断和治疗.结果 10例乳腺癌患者出现PICC相关有症状上肢静脉血栓,发生率为1.1％ (10/938),每1000个导管留置日中的血栓例数为0.11,共携带导管1035 d,置管后血栓发生中位时间23.5 (4～176)d,9例患者采用低分子肝素抗凝,中位抗凝时间为14(3 ～50)d,5例患者抗凝后继续使用导管,所有患者均无肺栓塞发生.结论 PICC相关上肢静脉血栓形成在乳腺癌化疗患者中发生率低,早期诊断及治疗后,仍可取得较好的临床结局.