外周静脉置入中心静脉导管(PICC)在血液疾病患者中导管相关性血流感染及血栓形成的风险分析
|
摘要
目的:观察外周静脉置入中心静脉导管(peripherally inserted central catheters,PICC)对导管相关血流感染(catheter-related bloodstream infections,CRBSI)及患者导管相关血栓(catheter-related thrombotic complications,CRTC)形成的影响。方法:选取2013年1月-2016年12月本院收治的血液肿瘤患者共483例,共进行612次PICC置管,置管时间中位数101(48-184) d;观察CRBSI及CRTC的发生率,并对CRBSI及CRTC的相关变量进行Cox回归分析。结果:CRBSI共47例(7. 7%),发生率为0. 59‰导管日;而CRTC共16例(2. 6%),发生率为0. 20‰导管日,无其他相关严重并发症。CRBSI和CRTC相关的变量的Cox回归分析结果显示,与其他类型的疾病相比,急性白血病与CRBSI的高发病率显著相关,但与CRTC无显著相关。结论:与传统CVAD置管方法相比,PICC应用于恶性肿瘤患者具有更高的安全性,可成为CVAD有效的替代方案。
Objective: To evaluate the effects of peripheral introvascular central catheters( PICC) on the catheterassociated bloodstream infections( CRBSI) and the formations of catheter-related bloodstream infections. Methods:Total of 483 patients w ith hematologic malignancies admitted in our hospital from January 2013 to December 2016 w ere enrolled in this study,and 612 PICC catheterization w ere conducted. The median time of catheterization w as 101 d( 48～ 184 d). The incidence rates of CRBSI and CRTC w ere observed,and the CRBSI and CRTC associated variables w ere also analyzed. Results: There w ere 47 cases of CRBSI( 7. 7%),and the incidence w as 0. 59‰ PICC days,and there w ere 16 cases of CRTC( 2. 6%),w ith the incidence of 0. 20‰ PICC days. M eanw hile,no other related serious complications found. The Cox regression analysis of CRBSI and CRTC-associated variables show ed that the acute leukemia w as significantly related w ith a higher incidence of CRBSI as compared w ith the other type of disease,how ever,w hich w as not significantly related w ith the CRTC. Conclusion: Compared w ith the traditional CVAD catheterization,the PICC is more safe and effective for the patients w ith malignant tumors,thus w hich may become a alternative method for CVAD.
Objective: To evaluate the effects of peripheral introvascular central catheters( PICC) on the catheterassociated bloodstream infections( CRBSI) and the formations of catheter-related bloodstream infections. Methods:Total of 483 patients w ith hematologic malignancies admitted in our hospital from January 2013 to December 2016 w ere enrolled in this study,and 612 PICC catheterization w ere conducted. The median time of catheterization w as 101 d( 48～ 184 d). The incidence rates of CRBSI and CRTC w ere observed,and the CRBSI and CRTC associated variables w ere also analyzed. Results: There w ere 47 cases of CRBSI( 7. 7%),and the incidence w as 0. 59‰ PICC days,and there w ere 16 cases of CRTC( 2. 6%),w ith the incidence of 0. 20‰ PICC days. M eanw hile,no other related serious complications found. The Cox regression analysis of CRBSI and CRTC-associated variables show ed that the acute leukemia w as significantly related w ith a higher incidence of CRBSI as compared w ith the other type of disease,how ever,w hich w as not significantly related w ith the CRTC. Conclusion: Compared w ith the traditional CVAD catheterization,the PICC is more safe and effective for the patients w ith malignant tumors,thus w hich may become a alternative method for CVAD.
引文
1 Schwarz RE,Groeger JS,Coit DG.Subcutaneously implanted central venous access devices in cancer patients.Cancer,2015;79(8):1635-1640.
2文津,刘新宇,蒋先洪,等.介入治疗后中心静脉再置管在血管通路功能障碍中的应用.重庆医学,2016;45(14):1900-1901.
3 Mordenti P,Oleari F,Cavanna L.Peripherally inserted central catheters-improving appropriateness with a dedicated and rigorous team.JAMA Inter Med,2016;176(8):1225.
4 Bertoglio S,Faccini B,Lalli L,et al.Peripherally inserted central catheters(PICCs)in cancer patients under chemotherapy:A prospective study on the incidence of complications and overall failures.J Surg Oncol,2016l;113(6):708-714.
5 O'Grady NP,Alexander M,Dellinger EP,et al.Guidelines for the Prevention of Intravascular Catheter-related Infections.Infect Cont Hospe,2011;23(12):759-769.
6万正东,宋斌,雷红卫,等.人造血管透析通路血栓性狭窄与闭塞的介入治疗探讨.中国现代医学杂志,2017;27(5):138-140.
7唐文珏,阮毅燕.细胞免疫与免疫性血小板减少症的关系.广东医学,2016;37(11):1729-1731.
8 Morano SG,Latagliata R,Girmenia C,et al.Catheter-associated bloodstream infections and thrombotic risk in hematologic patients with peripherally inserted central catheters(PICC).Support Care Cancer,2015;23(11):3289-3295.
9黎容清,江岱琪,吕玉洁.不同病原菌所致PICC相关血流感染的观察与护理.中华护理杂志,2016;51(11):1368-1370.
10周啟志.中心静脉导管相关血流感染的危险因素与预防控制进展.中国消毒学杂志,2015;32(3):265-268.
11邹红玲,黄芊芊,杨文哲.肿瘤医院各科室外周性静脉导管与中心静脉导管使用及感染情况对比分析.广东医学,2016;37(s1):162-165.
12成水芹,许书添,郭锦洲,等.肾脏科重症监护室患者中心静脉导管相关血流感染的临床特征与危险因素.肾脏病与透析肾移植杂志,2016;25(5):431-436.
13胡蒙.PICC置管术后上肢深静脉血栓发生率及相关危险因素分析.天津医科大学,2015.
14于瑞,陈利芬.肿瘤患者PICC导管相关静脉血栓形成影响因素Meta分析.中国护理管理,2016;16(6):738-743.
15吕明恩,李洋,薛峰,等.应用未成熟血小板比例、未成熟血小板绝对值和血栓弹力图评估原发免疫性血小板减少症患者的出血风险.中华血液学杂志,2015;36(9):759-764.
2文津,刘新宇,蒋先洪,等.介入治疗后中心静脉再置管在血管通路功能障碍中的应用.重庆医学,2016;45(14):1900-1901.
3 Mordenti P,Oleari F,Cavanna L.Peripherally inserted central catheters-improving appropriateness with a dedicated and rigorous team.JAMA Inter Med,2016;176(8):1225.
4 Bertoglio S,Faccini B,Lalli L,et al.Peripherally inserted central catheters(PICCs)in cancer patients under chemotherapy:A prospective study on the incidence of complications and overall failures.J Surg Oncol,2016l;113(6):708-714.
5 O'Grady NP,Alexander M,Dellinger EP,et al.Guidelines for the Prevention of Intravascular Catheter-related Infections.Infect Cont Hospe,2011;23(12):759-769.
6万正东,宋斌,雷红卫,等.人造血管透析通路血栓性狭窄与闭塞的介入治疗探讨.中国现代医学杂志,2017;27(5):138-140.
7唐文珏,阮毅燕.细胞免疫与免疫性血小板减少症的关系.广东医学,2016;37(11):1729-1731.
8 Morano SG,Latagliata R,Girmenia C,et al.Catheter-associated bloodstream infections and thrombotic risk in hematologic patients with peripherally inserted central catheters(PICC).Support Care Cancer,2015;23(11):3289-3295.
9黎容清,江岱琪,吕玉洁.不同病原菌所致PICC相关血流感染的观察与护理.中华护理杂志,2016;51(11):1368-1370.
10周啟志.中心静脉导管相关血流感染的危险因素与预防控制进展.中国消毒学杂志,2015;32(3):265-268.
11邹红玲,黄芊芊,杨文哲.肿瘤医院各科室外周性静脉导管与中心静脉导管使用及感染情况对比分析.广东医学,2016;37(s1):162-165.
12成水芹,许书添,郭锦洲,等.肾脏科重症监护室患者中心静脉导管相关血流感染的临床特征与危险因素.肾脏病与透析肾移植杂志,2016;25(5):431-436.
13胡蒙.PICC置管术后上肢深静脉血栓发生率及相关危险因素分析.天津医科大学,2015.
14于瑞,陈利芬.肿瘤患者PICC导管相关静脉血栓形成影响因素Meta分析.中国护理管理,2016;16(6):738-743.
15吕明恩,李洋,薛峰,等.应用未成熟血小板比例、未成熟血小板绝对值和血栓弹力图评估原发免疫性血小板减少症患者的出血风险.中华血液学杂志,2015;36(9):759-764.