肺腺癌患者PICC置管后静脉血栓形成的危险因素分析

摘要

Objective To analyze the risk factors of venous thrombosis after peripherally inserted central catheter (PICC) in patients with lung adenocarcinoma. Method The clinical data of 537 patients with lung adenocarcinoma who were treated with PICC chemotherapy from March 2011 to March 2016 in our hospital were retrospectively analyzed. The risk factors of venous thrombosis after PICC catheterization were analyzed. Result In 537 cases of lung adenocarcinoma, PICC related venous thrombosis occurred in 37 cases, the incidence was 6.89%. Univariate analysis showed that age, platelet count, the puncture body and whether the use of anticoagulant drugs prevention measure had no significant differences on the incidence of thrombosis effects (P > 0.05), gender, puncture vein, fibrinogen (FIB) levels and body weight index (BMI) were the influence factors of PICC catheter after venous thrombosis (P < 0.05). Logistic multivariate regression analysis showed that female, puncture head vein, FIB level ≥ 4 g/L and BMI ≥ 25 kg/m2 were independent risk factors for PICC patients with lung adenocarcinomavenous thrombosis (P < 0.05). Among the female patients with lung adenocarcinoma, the incidence rate of PICC venous thrombosis was 14.69%, which was significantly higher than that of the patients aged from 35 to 50 years old (P < 0.05). Conclusion The risk of PICC venous thrombosis in female patients with lung adenocarcinoma is higher than that in male patients with lung adenocarcinoma, and the risk of PICC venous thrombosis is significantly increased in women aged> 50 years old. Clinical operation should be selected as the puncture point and improve the body weight and maintain the FIB level < 4 g/L, and reduce the risk of venous thrombosis after PICC catheterization.%目的 分析肺腺癌患者外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)后静脉血栓形成的危险因素.方法 回顾性分析2011年3月至2016年3月本院肿瘤科收治的行PICC化疗的537例肺腺癌患者的临床资料,分析PICC置管后静脉血栓形成的危险因素.结果 537例肺腺癌患者中,发生PICC相关静脉血栓37例,发生率为6.89%.单因素分析显示,年龄、血小板计数、穿刺肢体以及是否使用预防剂量抗凝药物对血栓发生率的影响无显著差异(P>0.05),性别、穿刺静脉、纤维蛋白原(fibrinogen,FIB)水平及体重指数(body mass index,BMI)是PICC置管后静脉血栓形成的影响因素(P<0.05).Logistic多元回归分析结果表明:女性、穿刺头静脉、FIB水平≥4 g/L及BMI≥25 kg/m2是肺腺癌患者PICC置管后静脉血栓形成的独立危险因素(P<0.05).年龄>50岁的女性肺腺癌患者PICC置管后静脉血栓发生率为14.69%,显著高于35~50岁女性肺腺癌患者(5.15%)(P<0.05).结论 女性肺腺癌患者PICC置管后静脉血栓发生风险高于男性肺腺癌患者,且年龄>50岁的女性肺腺癌患者PICC置管后静脉血栓发生风险显著增加.临床操作中应尽量选择贵要静脉为穿刺点,改善肥胖体质并保持FIB水平<4 g/L,以降低PICC置管后静脉血栓发生风险.