非肿瘤住院患者PICC导管相关性血栓形成风险研究

Abstract

目的目前有关经外周中心静脉置管(PICC)相关性深静脉血栓(RDVT)发生风险的研究多集中于肿瘤患者,而随着PICC临床应用范围的日益扩大,评估其在非肿瘤住院患者中的RDVT发生风险情况具有重要的临床意义,本研究旨在对上述问题进行初步探讨。方法收集并分析自2009年1月1日—2017年12月1日于航天中心医院神经内科住院且接受PICC置管治疗的非肿瘤患者相关的临床资料和实验室资料,并对患者PICC置管环境,导管结局和患者结局等资料进行统计分析,探讨PICC在非肿瘤住院患者中的PICC-RDVT的发生风险情况。同时采用计算机检索,对中国生物医学文献数据库、中国期刊全文数据库、维普期刊全文数据库、万方数据库、PubMed、EMBASE等中英文数据库中发表的,并以中国人群为研究对象,报道PICC在非肿瘤住院患者中RDVT的发生风险的相关研究进行系统评价。结果共341例PICC置管,199例为普通病房置管,142例为神经重症监护病房(NICU)置管。合并尿管留置262例。合并机械通气90例。发生症状性PICC-RDVT 17例,发生率为4.9%。系统评价结果显示符合纳入标准的研究共13篇,全部为中文文献。国内有关非肿瘤住院患者的PICC-RDVT发生风险的结果差异较大(0.3%～28.5%),总体特点为重症患者和老年患者的PICC-RDVT发生风险明显高于较轻型及年轻患者。结论非肿瘤住院患者的PICC-RDVT整体发生风险不高于肿瘤患者,仍需要进一步的研究来验证上述结论。

Objective The recent studies focused mostly on the risk of peripherally inserted central catheters-related deep vein thrombosis(PICC-DVT) in cancer patients. However, with the development of PICC, it is thought to be necessary to determine the risk of PICC-DVT in hospitalized non-cancer patients. The aim of this paper is to answer this question. Methods The clinical and lab data of non-cancer inpatient undergoing PICC in our hospital between January 2009 and December 2018 were reviewed. The statistical analysis was conducted on the catheterization environment, catheter outcomes and patient outcomes. The risk of PICC-DVT in non-cancer hospitalized patients was explored. A systematic literature study on the risk of PICC-DVT in Chinese inpatient was carried out by searching Chinese biomedical literature database, CNKI, Chinese medical journal database, Wang Fang Database, PubMed, EMBASE and so on. Results There were 341 PICCs were placed, among them, 199 PICC were inserted in general wards, 142 PICC were inserted in neurological intensive care unit. A total of 262 had urinary catheters, and 90 had received mechanical ventilation. Of the patients with PICCs, 17 patients developed a symptomatic PICC-DVT with an incidence of 4.9%. Thirteen articles were included and all were written in Chinese. Systematic review found that the domestic studies evaluating the risk of symptomatic PRDVT in non-cancer patients had large diversity(0.3% to 28.5%). The risk of PICC-DVT in critically patients and elderly patients was higher than that in the mild patients and young patients. Conclusion The risk of symptomatic PICC-DVT in non-cancer patients seems not higher than cancer patients. Future researches were needed to validate this conclusion.