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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(χ~2=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(χ~2=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。
Objective To investigate the influencing factors of complication of peripherally inserted central catheter (PICC) in patients with gynecologic chemotherapy (chemotherapy). Methods Patients with gynecologic oncology who received chemotherapy and were admitted to PICC between June 2015 and June 2016 were collected. Observe the patient complications, extubation reasons, the catheter tip position, the number of punctures, catheter site, catheterization time and extubation time. Results A total of 920 patients underwent PICC catheterization, of which 25 died and 83 were lost to follow-up. 104 patients were extubated due to complications. The median duration of PICC retention was 62 days. Complications included phlebitis [41.35% (43/104)] and thrombosis [25.96% (27/104)] were the most common . The incidence of complications in the left upper extremity [12.68% (53/418)] and the right upper extremity extubation (12.94% (51/394)] showed no significant difference (χ2 = 0.013, P> 0.05) There was no significant difference in the incidence of complications between vernacular cannulation [12.95% (72/556)] and upper arm vein [12.50% (32/256)] (χ ~ 2 = 0.032, P> 0.05). (28.57% (8/28)) in the non-superior vena cava and higher in the superior vena cava (12.24% (96/784)), with multiple (≥2) 30.19% (16/53)] were more successful than those with primary puncture [11.59% (88/759)]. The complication rates were higher (χ ~ 2 = 5.074,15.338, P <0.05). Conclusion The complications of PICC after gynecological chemotherapy are common. However, PICC is still a safer, more economical and home-care venous access.