长期卧床PICC置管患者上肢静脉血栓形成危险因素分析

赵海平　　钟玲玲

[关键词] PICC置管;上肢;静脉血栓;化疗史;导管堵塞;导管相关感染;导管移位;抗凝剂

[中图分类号] R714.6          [文献标识码] B          [文章编号] 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

外周靜脉置入中心静脉导管（Peripherally inserted central catheter，PICC）置管是通过外周静脉血管，置入导管到达心脏附近大血管，尖端位于上腔静脉或锁骨下静脉的方法，是中心静脉输液的有效渠道，为患者提供中长期输液、化疗、输血等治疗条件，避免各类药物对血管内膜的刺激，确保输液安全。导管材质为硅胶，柔软可弯曲，弹性好，对血管刺激小。上肢静脉血栓形成是PICC的主要并发症之一，一旦血栓形成后上肢肿胀、疼痛等，严重者甚至血栓脱落导致肺栓塞，影响患者的生命[1-2]。长期卧床患者常常伴有血流动力学异常，本身更容易发生血栓形成。本研究通过回顾性分析的方法探讨PICC置管患者上肢静脉血栓形成的危险因素，以期为临床预防提供参考，现报道如下。