妇科化学治疗患者经外周静脉置入中心静脉导管并发症原因分析_West China Medical Journal

Authors：

李德华 ¹ , 何亚林 ² , 明先 ² , 刘华琼 ² , 邓利容 ² , 龙德蓉 ²

1. ;
2. ;

Corresponding author：

龙德蓉, Email:

Keywords：

经外周静脉置入中心静脉导管; 妇科化疗; 并发症

DOI：

10.7507/1002-0179.201701022

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目的探讨妇科行化学治疗（化疗）患者经外周静脉置入中心静脉导管（peripherally inserted central catheter，PICC）并发症的影响因素。方法收集 2015 年 6 月—2016 年 6 月接受化疗并需要置入 PICC 的妇科肿瘤患者。观察患者并发症、拔管原因、导管头端位置、穿刺次数、置管部位、置管时间及拔管时间。结果 920 例患者成功接受 PICC 置管，其中随访中死亡 25 例，失访 83 例。104 例患者因并发症而提前拔管，其 PICC 留置时间中位数为 62 d，并发症以静脉炎[41.35%（43/104）]和血栓形成[25.96%（27/104）] 最常见。左上肢置管[12.68%（53/418）]与右上肢置管[12.94%（51/394）]的并发症发生率比较差异无统计学意义（χ²=0.013，P>0.05），肘前窝静脉置管[12.95%（72/556）] 与上臂静脉置管[12.50%（32/256）] 的并发症发生率比较差异无统计学意义（χ²=0.032，P>0.05）。导管头端位于非上腔静脉者[28.57%（8/28）] 较位于上腔静脉者[12.24%（96/784）] 并发症发生率更高，多次（≥2次）穿刺者[30.19%（16/53）] 较 1 次穿刺成功者[11.59%（88/759）] 并发症发生率更高，差异均有统计学意义（χ²=5.074、15.338，P<0.05）。结论妇科化疗患者 PICC 置管后并发症较常见。但 PICC 仍是一种较安全、经济、能家庭护理的静脉通路。

Citation： 李德华, 何亚林, 明先, 刘华琼, 邓利容, 龙德蓉. 妇科化学治疗患者经外周静脉置入中心静脉导管并发症原因分析. West China Medical Journal, 2017, 32(9): 1427-1429. doi: 10.7507/1002-0179.201701022 Copy

1.	Hadaway LC. Major thrombotic and nonthrombotic complications. Loss of patency. J Intraven Nur, 1998, 21(5 Suppl): S143-S160.
2.	郑春辉, 王凤, 陈强谱. 经外周穿刺置入中心静脉导管的并发症及防治. 中华护理杂志, 2004, 39(9): 700-702.
3.	王秀荣, 蒋朱明, 马恩陵. 640 例经外周静脉置入中心静脉导管的回顾. 中国临床营养杂志, 2002, 10(2): 133-134.
4.	王亚丽. PICC 与 CVC 在胃肠外营养治疗中的应用效果对比. 医疗装备, 2017, 30(12): 147-148.
5.	DG Maki. Infections caused by intravascular devices used for infusion therapy: pathogenesis, prevention, and management. Infections associated with indwelling medical devices. 2nd ed. Washington: American Society for Microbiology, 1994, 2: 155-212.
6.	黎玉国, 蒋朱明. 肠外营养新途径 (PICC 技术). 中国临床营养杂志, 2000, 8(3): 181-183.
7.	Goodwin ML, Carlson I. The peripherally inserted central catheter: a retrospective look at three years of insertions. J Intraven Nurs, 1993, 16(2): 92-103.
8.	Loughran SC, Borzatta M. Peripherally inserted central catheters: a report of 2506 catheter days. JPEN J Parenter Enteral Nutr, 1995, 19(2): 133-136.
9.	Loewenthal MR, Dobson PM, Starkey RE, et al. The peripherally inserted central catheter (PICC): a prospective study of its natural history after cubital fossa insertion. Anaesth Intensive Care, 2002, 30(1): 21-24.
10.	Monreal M, Quilez F, Rey-Joly C, et al. Infusion phlebitis in patients with acute pneumonia: a prospective study. Chest, 1999, 115(6): 1576-1580.
11.	James L, Bledsoe L, Hadaway LC. A retrospective look at tip location and complications of peripherally inserted central catheter lines. J Intraven Nurs, 1993, 16(2): 104-109.
12.	Montalto M. How safe is hospital-in-the-home care?. Med J Aust, 1998, 168(6): 277-280.
13.	赵中月. 喜疗妥用于 PICC 置管患者预防早期机械性静脉炎的效果观察. 中华现代护理学杂志, 2012.
14.	Thomas MV, Marc S, Sue M, et al. The diverse and conflicting standards and practices in infusion therapy. J Vascular Access Devices, 2002, 7(3): 9-25.
15.	刘小娜. 肿瘤化疗患者留置 PICC 并发静脉血栓的临床护理. 辽宁医学杂志, 2015(2): 113-114.
16.	Mermel LA. Prevention of intravascular catheter-related infections. Ann Intern Med, 2000, 132(5): 391-402.
17.	Moureau NL, Mckinnon BT, Claudia MD. Multidisciplinary management of thrombotic catheter occlusions in vascular access devices. J Vascular Access Devices, 1999, 4(2): 22-29.
18.	齐敏. PICC 和 CVC 置管技术在恶性肿瘤患者静脉治疗中的应用效果对比. 中国医药指南, 2015(35): 136-137.

1. Hadaway LC. Major thrombotic and nonthrombotic complications. Loss of patency. J Intraven Nur, 1998, 21(5 Suppl): S143-S160.
2. 郑春辉, 王凤, 陈强谱. 经外周穿刺置入中心静脉导管的并发症及防治. 中华护理杂志, 2004, 39(9): 700-702.
3. 王秀荣, 蒋朱明, 马恩陵. 640 例经外周静脉置入中心静脉导管的回顾. 中国临床营养杂志, 2002, 10(2): 133-134.
4. 王亚丽. PICC 与 CVC 在胃肠外营养治疗中的应用效果对比. 医疗装备, 2017, 30(12): 147-148.
5. DG Maki. Infections caused by intravascular devices used for infusion therapy: pathogenesis, prevention, and management. Infections associated with indwelling medical devices. 2nd ed. Washington: American Society for Microbiology, 1994, 2: 155-212.
6. 黎玉国, 蒋朱明. 肠外营养新途径 (PICC 技术). 中国临床营养杂志, 2000, 8(3): 181-183.
7. Goodwin ML, Carlson I. The peripherally inserted central catheter: a retrospective look at three years of insertions. J Intraven Nurs, 1993, 16(2): 92-103.
8. Loughran SC, Borzatta M. Peripherally inserted central catheters: a report of 2506 catheter days. JPEN J Parenter Enteral Nutr, 1995, 19(2): 133-136.
9. Loewenthal MR, Dobson PM, Starkey RE, et al. The peripherally inserted central catheter (PICC): a prospective study of its natural history after cubital fossa insertion. Anaesth Intensive Care, 2002, 30(1): 21-24.
10. Monreal M, Quilez F, Rey-Joly C, et al. Infusion phlebitis in patients with acute pneumonia: a prospective study. Chest, 1999, 115(6): 1576-1580.
11. James L, Bledsoe L, Hadaway LC. A retrospective look at tip location and complications of peripherally inserted central catheter lines. J Intraven Nurs, 1993, 16(2): 104-109.
12. Montalto M. How safe is hospital-in-the-home care?. Med J Aust, 1998, 168(6): 277-280.
13. 赵中月. 喜疗妥用于 PICC 置管患者预防早期机械性静脉炎的效果观察. 中华现代护理学杂志, 2012.
14. Thomas MV, Marc S, Sue M, et al. The diverse and conflicting standards and practices in infusion therapy. J Vascular Access Devices, 2002, 7(3): 9-25.
15. 刘小娜. 肿瘤化疗患者留置 PICC 并发静脉血栓的临床护理. 辽宁医学杂志, 2015(2): 113-114.
16. Mermel LA. Prevention of intravascular catheter-related infections. Ann Intern Med, 2000, 132(5): 391-402.
17. Moureau NL, Mckinnon BT, Claudia MD. Multidisciplinary management of thrombotic catheter occlusions in vascular access devices. J Vascular Access Devices, 1999, 4(2): 22-29.
18. 齐敏. PICC 和 CVC 置管技术在恶性肿瘤患者静脉治疗中的应用效果对比. 中国医药指南, 2015(35): 136-137.

West China Medical Journal

妇科化学治疗患者经外周静脉置入中心静脉导管并发症原因分析

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