重症神经疾病患者PICC术后并发深静脉血栓的临床特点分析及干预
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摘要
目的了解重症神经疾病患者经外周静脉置入中心静脉导管(PICC)术后并发深静脉血栓形成(DVT)的临床特点及其有效的干预措施。方法回顾性分析该院2013年7月至2014年12月收治的99例行PICC术重症神经疾病患者的临床资料。根据DVT是否形成分为发生组(5例)和未发生组(94例),分析两组患者年龄、性别、急性生理和慢性健康估测评分(APACHEⅡ)、D-二聚体水平、意识状态、疾病分布、穿刺侧部位及肌力、DVT发生时间及部位等。结果 99例患者共放置PICC 99根,深静脉血栓形成5例,发生率为5.05%;两组患者APACHEⅡ分值、意识状态、疾病分布比较,差异均有统计学意义(P<0.05);左右侧肢体、不同肌力DVT发生率比较,差异均有统计学意义(P<0.05);DVT发生时间主要集中在置管后小于或等于7 d;主要发生部位为锁骨下静脉。结论 APACHEⅡ分值高、D-二聚体水平高、昏迷、脑血管疾病患者均为PICC置管后并发DVT的高危人群;DVT主要发生于穿刺侧为右上肢、肌力小于或等于3级者,因此,PICC穿刺部位应首选健侧肢体,其次为右侧肢体,并采取有效的干预措施预防和控制DVT的发生、发展。
Objective To investigate the clinical characteristics and effective interventional measures of complicating deep venous thrombosis(DVT) after peripherally inserted central catheter(PICC) in the patients with severe nerve disease.Methods The clinical data in 99 patients with severe nerve disease undergoing PICC in our hospital from July 2013 to December2014 were retrospectively analyzed. The patients were divided into the occurrence group(5 cases) and non-occurrence group(94cases) according to the DVT formation. The age,gender,acute physiology and chronic health score(APACHEⅡ),D-dimmer level,conscious status,disease distribution,puncture side and muscle strength,DVT occurrence time and location were analyzed in the two groups. Results Ninety-nine cases were placed 99 catheters of PICC,5 cases had DVT with the incidence rate of 5.05%;the APACHE II score,conscious status and disease distribution had statistical difference between the two groups(P<0.05);the occurrence rate of DVT had statistical difference between the left and right sides and among different muscle strengths(P<0.05);the DVT occurrence time was mainly concentrated at less 7 d or 7 d after placing catheter;the main occurrence site was subclavian vein. Conclusion The patients with high APACHE II score,high D-dimer level,coma and cerebral vascular disease are the high risk population with complicating DVT after PICC,DVT mainly occurs in the right upper limb,muscle strength ≤ 3 level,so selecting the unaffected side should be the first choice for PICC puncture site,followed by the right side of the body,furthermore the effective interventional measures should be adopted to prevent and control the occurrence and development of DVT.
Objective To investigate the clinical characteristics and effective interventional measures of complicating deep venous thrombosis(DVT) after peripherally inserted central catheter(PICC) in the patients with severe nerve disease.Methods The clinical data in 99 patients with severe nerve disease undergoing PICC in our hospital from July 2013 to December2014 were retrospectively analyzed. The patients were divided into the occurrence group(5 cases) and non-occurrence group(94cases) according to the DVT formation. The age,gender,acute physiology and chronic health score(APACHEⅡ),D-dimmer level,conscious status,disease distribution,puncture side and muscle strength,DVT occurrence time and location were analyzed in the two groups. Results Ninety-nine cases were placed 99 catheters of PICC,5 cases had DVT with the incidence rate of 5.05%;the APACHE II score,conscious status and disease distribution had statistical difference between the two groups(P<0.05);the occurrence rate of DVT had statistical difference between the left and right sides and among different muscle strengths(P<0.05);the DVT occurrence time was mainly concentrated at less 7 d or 7 d after placing catheter;the main occurrence site was subclavian vein. Conclusion The patients with high APACHE II score,high D-dimer level,coma and cerebral vascular disease are the high risk population with complicating DVT after PICC,DVT mainly occurs in the right upper limb,muscle strength ≤ 3 level,so selecting the unaffected side should be the first choice for PICC puncture site,followed by the right side of the body,furthermore the effective interventional measures should be adopted to prevent and control the occurrence and development of DVT.
引文
[1]蔡秀群,李懿.罕见PICC继发性异位致深静脉血栓合并颅内静脉窦血栓形成[J].中国医学创新,2014,11(26):133-135.
[2]唐仰璇,佘佩吟,方楚萍,等.1例PICC置管致严重静脉炎的干预措施[J].中国医学创新,2012,9(27):83-84.
[3]张凤云,马荣梅.PICC置管主要并发症相关原因分析及护理措施[J].中国医学创新,2012,9(28):51-52.
[4]张杏兰,侯斌斌,张杏红.自粘式聚氨酯敷料预防PICC机械性静脉炎的疗效观察[J].中国医学创新,2012,9(31):87-88.
[5]郑守华,李秋洁.临床肿瘤护理学[M].北京:人民卫生出版社,2008:114.
[6]汪利锐,许丽贞,黄雅楠,等.PICC置管患者并发深静脉血栓的相关因素及护理[J].中外医学研究,2009,7(10):142.
[7]赵金柱,曲良,宋展昭.全髋关节置换术后深静脉血栓栓塞症的发生与改良APACHEⅡ评分相关性研究[J].中国矫形外科杂志,2011,19(19):1589-1591.
[8]巩忠,郑典刚,李东华,等.脑卒中后偏瘫患者症状性下肢深静脉血栓形成的临床特点[J].中西医结合心脑血管病杂志,2012,10(7):820-821.
[9]Stokowski G,Steele D,Wilson D.The use of ultrasound to improve practice and reduce complication rates in peripherally inserted central catheter insertions:final report of investigation[J].J Infus Nurs,2009,32(3):145-155.
[10]李朝明,郑琦.Wells评分和血浆D-二聚体检测在诊断骨折患者下肢深静脉血栓形成中的应用分析[J/CD].中国危重症医学杂志:电子版,2013,6(1):41-43.
[11]Allen AW,Megargell JL,Brown DB,et al.Venous thrombosis associated with the placement of peripherally inserted central catheters[J].J Vasc Interv Radiol,2000,11(10):1309-1314.
[12]邢雷,孔令泉,厉红元,等.乳腺癌患者携带PICC化疗并发PICC相关性上肢深静脉血栓形成的诊治探讨[J].中国肿瘤临床,2011,38(19):1223-1226.
[13]张秀玲,柳建华.彩超对肿瘤患者PICC术后上肢静脉血栓的诊断价值[J].临床医学工程,2015,22(2):153-154.
[14]石凤英.康复护理学[M].北京:人民卫生出版社,2006:86-87.
[2]唐仰璇,佘佩吟,方楚萍,等.1例PICC置管致严重静脉炎的干预措施[J].中国医学创新,2012,9(27):83-84.
[3]张凤云,马荣梅.PICC置管主要并发症相关原因分析及护理措施[J].中国医学创新,2012,9(28):51-52.
[4]张杏兰,侯斌斌,张杏红.自粘式聚氨酯敷料预防PICC机械性静脉炎的疗效观察[J].中国医学创新,2012,9(31):87-88.
[5]郑守华,李秋洁.临床肿瘤护理学[M].北京:人民卫生出版社,2008:114.
[6]汪利锐,许丽贞,黄雅楠,等.PICC置管患者并发深静脉血栓的相关因素及护理[J].中外医学研究,2009,7(10):142.
[7]赵金柱,曲良,宋展昭.全髋关节置换术后深静脉血栓栓塞症的发生与改良APACHEⅡ评分相关性研究[J].中国矫形外科杂志,2011,19(19):1589-1591.
[8]巩忠,郑典刚,李东华,等.脑卒中后偏瘫患者症状性下肢深静脉血栓形成的临床特点[J].中西医结合心脑血管病杂志,2012,10(7):820-821.
[9]Stokowski G,Steele D,Wilson D.The use of ultrasound to improve practice and reduce complication rates in peripherally inserted central catheter insertions:final report of investigation[J].J Infus Nurs,2009,32(3):145-155.
[10]李朝明,郑琦.Wells评分和血浆D-二聚体检测在诊断骨折患者下肢深静脉血栓形成中的应用分析[J/CD].中国危重症医学杂志:电子版,2013,6(1):41-43.
[11]Allen AW,Megargell JL,Brown DB,et al.Venous thrombosis associated with the placement of peripherally inserted central catheters[J].J Vasc Interv Radiol,2000,11(10):1309-1314.
[12]邢雷,孔令泉,厉红元,等.乳腺癌患者携带PICC化疗并发PICC相关性上肢深静脉血栓形成的诊治探讨[J].中国肿瘤临床,2011,38(19):1223-1226.
[13]张秀玲,柳建华.彩超对肿瘤患者PICC术后上肢静脉血栓的诊断价值[J].临床医学工程,2015,22(2):153-154.
[14]石凤英.康复护理学[M].北京:人民卫生出版社,2006:86-87.