老年患者PICC置管术后上肢深静脉血栓的临床特征研究

发布时间：2018-08-01 09:09

【摘要】：目的：对老年患者PICC管置入术后血栓发生的多种因素进行分析,以提高对老年患者PICC置管术后上肢深静脉血栓的认识,加强血栓的预防,减少并发症的发生。方法：对2008年1月-2013年12月间我院西院行PICC管置入且病例资料详备的650例患者进行回顾性分析。收集患者的一般资料、置管情况及血栓形成等数据并建立数据库,然后对结果进行统计分析。统计软件应用SPSS20.0软件包。统计方法包括：单因素分析采用卡方检验和t检验,多因素分析采用logistic多元回归分析,所用的统计结果均以P0.05为有显著性检验水平。结果：共有650例患者纳入本研究,发生上肢深静脉血栓者233例,血栓发生率为35.8%。650例患者中年龄在60-102岁之间,中位年龄82岁,平均年龄81.5±9.3岁,男性628例,女性22例,男女比例28.5：1。单因素分析结果显示,血栓组患者的年龄和BMI显著高于对照组,而且在血栓组患者中,有恶性肿瘤、血栓病史、慢性肾功能不全、近期手术外伤史、左臂置管、PICC管尖端在无名静脉或锁骨下静脉的患者比例要明显高于对照组,而对照组中右臂置管、PICC管尖端在上腔静脉的患者比例要高于血栓组,P0.05; logistic多元回归分析结果显示,在性别、年龄、BMI、慢性肾功能不全、近期手术外伤史、置管手臂、PICC管尖端位置等诸多因素中,年龄、慢性肾功能不全和近期手术外伤史具有统计学差异,提示这三个因素是老年患者PICC置管术后血栓形成的独立危险因素。结论：1.单因素分析结果显示,老年患者PICC置管术后血栓形成的危险因素有年龄、BMI、恶性肿瘤、血栓病史、慢性肾功能不全、近期手术外伤史、置管手臂、PICC管尖端位置。2. logistic多元回归分析结果显示,年龄、慢性肾功能不全和近期手术外伤史是老年患者PICC置管术后血栓形成的独立危险因素。目的：研究老年患者PICC导管相关上肢深静脉血栓的治疗效果及其影响因素。方法：选择我院2008年1月到2013年12月明确诊断为PICC导管相关上肢深静脉血栓患者126例,收集患者的一般资料、基础疾病史、置管相关信息、血栓相关数据、是否拔除导管、超声随访结果以及是否抗栓治疗等数据并建立数据库,然后对结果进行统计分析。统计软件应用SPSS20.0软件包。统计方法包括：单因素分析采用卡方检验和t检验,累积再通率采用Kaplan-Meier分析,所有统计结果均以P0.05为有显著性检验水平。结果：126例患者中男性116例,女性10例,平均年龄86.8±6.3岁(69-99岁),其中有症状性血栓患者49例(38.9%),无症状性血栓患者77例(61.1%),血栓症状主要包括：上肢水肿(32例)、疼痛(11例)以及疼痛伴水肿(6例)。发现上肢深静脉血栓时置管时间平均为52.2±72.1天,最短7天,最长379天。发现血栓后接受抗栓治疗患者100例,未抗栓治疗患者26例,抗栓治疗的平均天数为35.4±5.0天,最短7天,最长279天。血栓完全再通66例,部分再通21例,无变化24例,血栓进展15例。根据患者的抗栓治疗效果将患者分为再通组与不通组,将患者的一般资料与基础疾病情况进行比较,结果显示两组间各因素水平均无明显统计学差异(P0.05)。将两组患者的导管相关信息包括置管天数、置管手臂、是否拔除导管、是否接受抗栓治疗和血栓的位置进行比较,结果显示,再通组患者中拔除导管和接受抗栓治疗的患者比例明显高于不通组,两组间有统计学差异；拔除导管的患者其上肢深静脉血栓完全再通的比例明显高于未拔除导管患者(63.7%vs22.9%);接受抗栓治疗的患者其上肢深静脉血栓完全再通率和部分再通率分别为62%和20%,明显高于未接受抗栓治疗患者的完全再通率和部分再通率,分别为15.4%和3.8%。Kaplan-Meier分析结果显示,发现血栓后拔除导管组以及接受抗栓治疗组,其累积再通率要明显高于未拔除导管组和未接受抗栓治疗组,P0.05。结论：1. PICC导管相关上肢深静脉血栓的治疗与是否拔除导管及接受抗栓治疗有关,拔除导管和接受抗栓治疗者其血栓治疗效果更优;2.患者的年龄、性别、BMI、基础疾病史、置管手臂、置管天数、血栓位置等因素与PICC导管相关上肢深静脉血栓的治疗效果无明显相关;3.当出现PICC管相关性血栓的时候拔管和抗栓治疗同样重要,但是拔管后在新的位置置管导致再次发生血栓的机会增大,因此对于症状不严重、导管仍有用途、没有感染迹象的老年患者,我们主张保留置管,这样的结论有助于简化和明确PICC导管相关性血栓的处理流程,为临床工作提供明确的指导。
[Abstract]:Objective: to analyze the various factors of thrombosis after PICC tube implantation in elderly patients, in order to improve the understanding of the deep venous thrombosis of the upper limb after PICC catheterization in the elderly patients, to strengthen the prevention of thrombus and to reduce the occurrence of complications. Methods: 650 cases of PICC tube implantation in the West Hospital of our hospital in January 2008 and the data of the cases were prepared in detail. The patients were analyzed retrospectively. The general data of the patients, the catheterization and thrombus formation data were collected and the database was established, and then the results were statistically analyzed. The statistical software was applied to the SPSS20.0 software package. The statistical methods included the single factor analysis using the chi square test and the t test, and the multiple factor analysis using logistic multivariate regression analysis. The statistical results were measured with P0.05 as a significant test. Results: a total of 650 patients were included in this study, with 233 cases of deep vein thrombosis in the upper extremity. The incidence of thrombus was between the age of 60-102 years in the 35.8%.650 patients, the median age of 82 years, the average age of 81.5 + 9.3 years, the male 628 cases, the female 22 cases, and the male and female ratio 28.5:1. single factor. The results showed that the age and BMI of the patients in the thrombus group were significantly higher than those in the control group, and in the patients with thrombus group, there were malignant tumors, thrombus history, chronic renal insufficiency, recent surgical trauma history, left arm catheterization, and the proportion of patients with the PICC tube tip in the innominate vein or subclavian vein was significantly higher than that in the control group, while the right arm was placed in the control group. The proportion of the PICC tube tip in the superior vena cava was higher than that in the thrombus group, P0.05. The results of logistic multivariate regression analysis showed that age, chronic renal insufficiency and recent surgical trauma history had statistical differences in many factors, such as sex, age, BMI, chronic renal insufficiency, recent surgical trauma history, intubation arm, PICC tube tip position, and so on. These three factors are independent risk factors for thrombus formation after PICC catheterization in elderly patients. Conclusion: 1. single factor analysis results show that the risk factors of thrombosis in elderly patients after PICC catheterization are age, BMI, malignant tumor, thrombus history, chronic renal insufficiency, recent surgical trauma history, intubation arm, and PICC tube tip position.2. Logistic multivariate regression analysis showed that age, chronic renal insufficiency and recent surgical trauma history were independent risk factors for thrombus formation in elderly patients after PICC catheterization. Objective: To study the therapeutic effect of PICC catheter related deep venous thrombosis in elderly patients and its influence factors. Methods: select our hospital from January 2008 to 2013 12 126 cases of PICC related upper limb deep venous thrombosis were diagnosed in the month. The general data of the patients, the history of the basic disease, the related information of the catheter, the data of thrombus related, whether the catheter was removed, the results of ultrasound follow-up and the antithrombotic treatment were established and the database was established, and then the results were statistically analyzed. The statistical software applied SPSS20.0 Software package. Statistical methods include: single factor analysis using chi square test and t test, cumulative recurrence rate using Kaplan-Meier analysis, all statistical results are P0.05 as a significant test level. Results: 126 cases of male 116 cases, female 10 cases, average age 86.8 + 6.3 years (69-99 years), among them 49 cases of symptomatic thrombus (38.9%), There were 77 cases (61.1%) of asymptomatic thrombus, including upper limb edema (32 cases), pain (11 cases), and pain accompanied by edema (6 cases). The average time of the upper limb deep vein thrombosis was 52.2 + 72.1 days, the shortest 7 days, and the longest 379 days. 100 patients received thrombolytic therapy, 26 antithrombotic treatment and antithrombotic therapy were found. The average days were 35.4 + 5 days, the shortest 7 days and the longest 279 days. The thrombus was completely re passed in 66 cases, 21 cases were re passed, 24 cases without change, and 15 cases of thrombus progression. According to the effect of antithrombotic therapy, the patients were divided into the re group and the failure group. The general data of the patients were compared with the basic disease conditions, and the results showed that the levels of the factors among the two groups were all level. There was no significant difference in Statistics (P0.05). The catheter related information of two groups of patients, including the number of catheterization days, the placement of the tube arm, whether the catheter was removed, whether the thrombolytic therapy and the thrombus were accepted, was compared. The results showed that the ratio of the catheter removal and the antithrombotic treatment was significantly higher in the patients in the re group than in the failure group, and the two groups were statistically poor. The rate of complete recanalization of deep vein thrombosis in the upper extremity was significantly higher than that in patients without catheterization (63.7%vs22.9%). The total recanalization rate and partial recanalization rate of the upper limb deep vein thrombosis in patients receiving antithrombotic therapy were 62% and 20% respectively, significantly higher than the complete recanalization rate and partial recanalization rate in patients who had not received antithrombotic therapy. The results of 15.4% and 3.8%.Kaplan-Meier analysis showed that the cumulative recanalization rate of the thrombolytic catheter group and the antithrombotic treatment group was significantly higher than that of the unpulled catheter group and the untreated group. P0.05. conclusion: the treatment of the 1. PICC catheter related upper limb deep vein thrombosis and the removal of the catheter and the treatment of antithrombotic therapy The effect of thrombus therapy was better in the patients who had been removed and treated with antithrombotic therapy. The age, sex, BMI, BMI, the history of basic disease, the number of intubation arms, the number of catheterization and the position of thrombus were not significantly related to the treatment effect of the PICC catheter related upper limb deep vein thrombosis; 3. when the PICC tube related thrombus was found, extubation and antithrombotic treatment were the same It is important, but the opportunity for a new location after extubation leads to an increased chance of a recurrence of thrombus. Therefore, for the elderly patients with no serious symptoms, the catheter is still useful, and there is no sign of infection in the elderly, we advocate the retention of the catheterization. This conclusion helps to simplify and clarify the process of PICC catheter related thrombus treatment and provide clear clinical work. Guidance.
【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R543.6

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