PICC患者相关性血栓形成的危险因素分析

赵栩钰　边春鸽　钟玲玲

[摘要] 目的 探讨PICC患者相关性血栓形成的危险因素分析。 方法 选择2018年2月至2019年12月在诸暨市人民医院行PICC的患者413例为研究对象，统计发生PICC导管相关性血栓例数，单因素及多因素分析PICC患者相关性血栓形成的危险因素。 结果 ①共纳入413例PICC置管患者，23例发生PICC导管相关性血栓，发生率为5.57%。②单因素分析结果显示，尖端位置位于T4、T5，APACHEⅡ>26分、FIB>4.5 g/L、恶性肿瘤患者血栓发生率更高（P<0.05）。③多因素分析结果显示，尖端位置位于T4、T5、APACHEⅡ>26分、FIB>4.5 g/L、恶性肿瘤是PICC导管相关性血栓形成的独立危险因素（P<0.05）。 结论 PICC患者有一定的比例发生导管相关性血栓，尖端位置高、APACHEⅡ分高、FIB水平高是PICC导管相关性血栓形成的独立危险因素，在临床工作中应根据情况积极预防。

[关键词] 经外周静脉穿刺中心静脉置管;相关性;血栓;危险因素

[中图分类号] R730.5          [文献标识码] B          [文章编号] 1673-9701（2021）04-0094-04

Analysis of the risk factors of PICC-related thrombosis

ZHAO Xuyu1   BIAN Chunge1   ZHONG Lingling2

1.Department of Hematology， Zhuji People′s Hospital in Zhejiang Province， Zhuji   311800， China; 2.PICC Specialist， Zhejiang Provincial Tongde Hospital， Hangzhou   310012， China

[Abstract] Objective To explore the risk factors of thrombosis associated with PICC. Methods A total of 413 patients who underwent PICC in People′s Hospital from February 2018 to December 2019 were selected as the research object. The number of PICC catheter-related thrombosis cases was counted. Univariate analysis and multivariate analysis were used to analyze the risk factors of PICC-related thrombosis. Results ①A total of 413 patients with PICC catheterization were included， and 23 patients had PICC catheter-related thrombosis， with an incidence of 5.57%.②The incidence of thrombosis was higher in malignant tumors patients with tip position at T4， T5， APACHEⅡ>26 points， FIB>4.5 g/L（P<0.05）.③Multivariate analysis results showed that the tip position at T4， T5， APACHE Ⅱ>26 points， FIB>4.5 g/L， and malignant tumor were independent risk factors for PICC catheter-related thrombosis（P<0.05）. Conclusion PICC patients have a certain proportion of catheter-related thrombosis. High tip position， high APACHE Ⅱ score，and high FIB level are independent risk factors for PICC catheter-related thrombosis.In clinical work，it should be actively prevented according to the situation.

[Key words] Central venous catheterization via peripheral venipuncture; Correlation; Thrombosis; Risk factors

經外周静脉穿刺中心静脉置管（Peripherally inserted central venous catheters，PICC）是指通过外周静脉血管，置入导管，到达心脏附近大血管，尖端定位于上腔静脉或锁骨下静脉的方法，是医疗护理领域的一项新技术，是中心静脉输液的可靠渠道。导管为硅胶材料，具有柔软、弹性好、对血管刺激性小等优点，导管可留置较长时间，可达数月甚至一年，减少反复静脉穿刺的痛苦，且不会影响肢体互动，日常生活不受影响，并且导管不会影响肢体活动，日常生活不受影响[1-2]。PICC为治疗提供可靠的静脉通路，提高输液安全性，但也具有一定的并发症，如穿破血管、送管不畅、误伤动脉、血栓形成等[3-4]。PICC导管相关性血栓是严重并发症之一，可发生皮肤颜色改变、面部肿胀、疼痛、肢端麻木、呼吸困难、甚至心动过速[5-6]。了解PICC导管相关性血栓形成的危险因素，采用积极的措施进行预防，对预防PICC导管相关性血栓形成及严重不良后果具有重要的临床意义。本研究探讨P……