本文選題：PICC + 血栓　； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:1.應(yīng)用Meta分析法進(jìn)一步明確PICC相關(guān)性上肢靜脈血栓的危險(xiǎn)因素。2.在確定血栓危險(xiǎn)因素的基礎(chǔ)上,初步建立PICC相關(guān)性上肢靜脈血栓風(fēng)險(xiǎn)評估模型,為識別置管的高�；颊吆皖A(yù)防血栓的發(fā)生提供理論依據(jù)。方法:1.計(jì)算機(jī)檢索國內(nèi)外數(shù)據(jù)庫,主要為CNKI、Wan Fang、Pub Med、Embase、Science Direct和Cochrane Library中公開發(fā)表的關(guān)于PICC相關(guān)性上肢靜脈血栓形成影響因素的文獻(xiàn)。用Cochrane協(xié)作網(wǎng)提供的Meta分析軟件即Revman5.3對提取到的納入文獻(xiàn)的數(shù)據(jù)資料進(jìn)行定量分析。分類資料的合并效應(yīng)量用比值比(odds ratio,OR)及95%可信區(qū)間(confidence interval,CI)表示。2.回顧性研究分析2015年7月至2016年2月在山西省某三級甲等綜合醫(yī)院就診并住院的146例PICC置管患者的病例資料,包括PICC相關(guān)性血栓組12例,非血栓組134例。以是否發(fā)生PICC相關(guān)性上肢靜脈血栓作為因變量,以Meta分析后有意義的危險(xiǎn)因素即肥胖(BMI≥30)、癌癥、血栓史、PICC或CVC置管史、穿刺次數(shù)≥2次、置管側(cè)肢體腫脹、臥床72h為自變量,建立Logistic回歸模型。結(jié)果:1.按照文獻(xiàn)篩選的流程和標(biāo)準(zhǔn),最終納入10篇文獻(xiàn),包括5篇隊(duì)列研究,5篇病例對照研究。研究總病例數(shù)為3471例,血栓組為662例,非血栓組為2809例。Meta分析的合并結(jié)果中具有統(tǒng)計(jì)學(xué)意義的有7項(xiàng)因素,即肥胖(BMI≥30):OR=2.20,95%CI(1.41,3.44);癌癥:OR=1.68,95%CI(1.12,2.53);血栓史:OR=1.77,95%CI(1.36,2.32);PICC或CVC置管史:OR=3.83,95%CI(1.51,9.66);穿刺次數(shù)≥2次:OR=1.77,95%CI(1.09,2.87);置管側(cè)肢體腫脹:OR=15.44,95%CI(6.44,37.05);臥床72h:OR=9.44,95%CI(3.87,23.02)。結(jié)果表明這些因素是影響血栓發(fā)生的危險(xiǎn)因素。2.依據(jù)Logistic回歸分析結(jié)果建立回歸模型,得到回歸模型為Logit(P)=-1.681+2.184×肥胖(BMI≥30)+2.283×癌癥+2.086×血栓史+2.177×PICC或CVC置管史+3.518×穿刺次數(shù)≥2次+3.027×置管側(cè)肢體腫脹+1.153×臥床72h。該模型的預(yù)測正確率為95.9%,ROC曲線下面積為0.908,統(tǒng)計(jì)學(xué)認(rèn)為對PICC相關(guān)性上肢靜脈血栓的發(fā)生有較好的預(yù)測能力。并且得到最佳臨界值為4.632,相應(yīng)的靈敏度和特異度是81.2%和75.7%。結(jié)論:本研究初步構(gòu)建了PICC相關(guān)性上肢靜脈血栓的風(fēng)險(xiǎn)評估模型,方便實(shí)用,可以幫助護(hù)理人員對PICC置管患者進(jìn)行個體化評估,明確高危患者,從而及早預(yù)防。
[Abstract]:Purpose 1. Meta analysis was used to further determine the risk factors of PICC associated upper limb venous thrombosis. 2. 2. On the basis of determining the risk factors of thrombus, a PICC related assessment model of venous thrombus risk in upper extremity was established to provide theoretical basis for identifying high risk patients with catheterization and preventing thrombosis. Method 1: 1. To search the domestic and foreign databases by computer, the literatures published in CNKI Wan Fangli Pub Medbase Science Direct and Cochrane Library on the influencing factors of PICC associated upper limb venous thrombosis were studied. The Meta-analysis software provided by Cochrane collaboration, Revman 5.3, was used to quantitatively analyze the data collected from the literature. The combined effect of classified data was expressed as odds ratio (OR) and 95% confidence interval (confidence CI). From July 2015 to February 2016, we retrospectively analyzed the data of 146 patients who were admitted to a general hospital in Shanxi province, including 12 patients with PICC-associated thrombus and 134 patients with non-thrombus. Whether or not PICC was associated with venous thrombosis in upper extremity was taken as dependent variable, obesity (BMI 鈮，

本文編號：2063634