【摘要】：目的：對老年患者PICC管置入術后血栓發(fā)生的多種因素進行分析,以提高對老年患者PICC置管術后上肢深靜脈血栓的認識,加強血栓的預防,減少并發(fā)癥的發(fā)生。方法：對2008年1月-2013年12月間我院西院行PICC管置入且病例資料詳備的650例患者進行回顧性分析。收集患者的一般資料、置管情況及血栓形成等數(shù)據(jù)并建立數(shù)據(jù)庫,然后對結果進行統(tǒng)計分析。統(tǒng)計軟件應用SPSS20.0軟件包。統(tǒng)計方法包括：單因素分析采用卡方檢驗和t檢驗,多因素分析采用logistic多元回歸分析,所用的統(tǒng)計結果均以P0.05為有顯著性檢驗水平。結果：共有650例患者納入本研究,發(fā)生上肢深靜脈血栓者233例,血栓發(fā)生率為35.8%。650例患者中年齡在60-102歲之間,中位年齡82歲,平均年齡81.5±9.3歲,男性628例,女性22例,男女比例28.5：1。單因素分析結果顯示,血栓組患者的年齡和BMI顯著高于對照組,而且在血栓組患者中,有惡性腫瘤、血栓病史、慢性腎功能不全、近期手術外傷史、左臂置管、PICC管尖端在無名靜脈或鎖骨下靜脈的患者比例要明顯高于對照組,而對照組中右臂置管、PICC管尖端在上腔靜脈的患者比例要高于血栓組,P0.05; logistic多元回歸分析結果顯示,在性別、年齡、BMI、慢性腎功能不全、近期手術外傷史、置管手臂、PICC管尖端位置等諸多因素中,年齡、慢性腎功能不全和近期手術外傷史具有統(tǒng)計學差異,提示這三個因素是老年患者PICC置管術后血栓形成的獨立危險因素。結論：1.單因素分析結果顯示,老年患者PICC置管術后血栓形成的危險因素有年齡、BMI、惡性腫瘤、血栓病史、慢性腎功能不全、近期手術外傷史、置管手臂、PICC管尖端位置。2. logistic多元回歸分析結果顯示,年齡、慢性腎功能不全和近期手術外傷史是老年患者PICC置管術后血栓形成的獨立危險因素。目的：研究老年患者PICC導管相關上肢深靜脈血栓的治療效果及其影響因素。方法：選擇我院2008年1月到2013年12月明確診斷為PICC導管相關上肢深靜脈血栓患者126例,收集患者的一般資料、基礎疾病史、置管相關信息、血栓相關數(shù)據(jù)、是否拔除導管、超聲隨訪結果以及是否抗栓治療等數(shù)據(jù)并建立數(shù)據(jù)庫,然后對結果進行統(tǒng)計分析。統(tǒng)計軟件應用SPSS20.0軟件包。統(tǒng)計方法包括：單因素分析采用卡方檢驗和t檢驗,累積再通率采用Kaplan-Meier分析,所有統(tǒng)計結果均以P0.05為有顯著性檢驗水平。結果：126例患者中男性116例,女性10例,平均年齡86.8±6.3歲(69-99歲),其中有癥狀性血栓患者49例(38.9%),無癥狀性血栓患者77例(61.1%),血栓癥狀主要包括：上肢水腫(32例)、疼痛(11例)以及疼痛伴水腫(6例)。發(fā)現(xiàn)上肢深靜脈血栓時置管時間平均為52.2±72.1天,最短7天,最長379天。發(fā)現(xiàn)血栓后接受抗栓治療患者100例,未抗栓治療患者26例,抗栓治療的平均天數(shù)為35.4±5.0天,最短7天,最長279天。血栓完全再通66例,部分再通21例,無變化24例,血栓進展15例。根據(jù)患者的抗栓治療效果將患者分為再通組與不通組,將患者的一般資料與基礎疾病情況進行比較,結果顯示兩組間各因素水平均無明顯統(tǒng)計學差異(P0.05)。將兩組患者的導管相關信息包括置管天數(shù)、置管手臂、是否拔除導管、是否接受抗栓治療和血栓的位置進行比較,結果顯示,再通組患者中拔除導管和接受抗栓治療的患者比例明顯高于不通組,兩組間有統(tǒng)計學差異；拔除導管的患者其上肢深靜脈血栓完全再通的比例明顯高于未拔除導管患者(63.7%vs22.9%);接受抗栓治療的患者其上肢深靜脈血栓完全再通率和部分再通率分別為62%和20%,明顯高于未接受抗栓治療患者的完全再通率和部分再通率,分別為15.4%和3.8%。Kaplan-Meier分析結果顯示,發(fā)現(xiàn)血栓后拔除導管組以及接受抗栓治療組,其累積再通率要明顯高于未拔除導管組和未接受抗栓治療組,P0.05。結論：1. PICC導管相關上肢深靜脈血栓的治療與是否拔除導管及接受抗栓治療有關,拔除導管和接受抗栓治療者其血栓治療效果更優(yōu);2.患者的年齡、性別、BMI、基礎疾病史、置管手臂、置管天數(shù)、血栓位置等因素與PICC導管相關上肢深靜脈血栓的治療效果無明顯相關;3.當出現(xiàn)PICC管相關性血栓的時候拔管和抗栓治療同樣重要,但是拔管后在新的位置置管導致再次發(fā)生血栓的機會增大,因此對于癥狀不嚴重、導管仍有用途、沒有感染跡象的老年患者,我們主張保留置管,這樣的結論有助于簡化和明確PICC導管相關性血栓的處理流程,為臨床工作提供明確的指導。
[Abstract]:Objective: to analyze the various factors of thrombosis after PICC tube implantation in elderly patients, in order to improve the understanding of the deep venous thrombosis of the upper limb after PICC catheterization in the elderly patients, to strengthen the prevention of thrombus and to reduce the occurrence of complications. Methods: 650 cases of PICC tube implantation in the West Hospital of our hospital in January 2008 and the data of the cases were prepared in detail. The patients were analyzed retrospectively. The general data of the patients, the catheterization and thrombus formation data were collected and the database was established, and then the results were statistically analyzed. The statistical software was applied to the SPSS20.0 software package. The statistical methods included the single factor analysis using the chi square test and the t test, and the multiple factor analysis using logistic multivariate regression analysis. The statistical results were measured with P0.05 as a significant test. Results: a total of 650 patients were included in this study, with 233 cases of deep vein thrombosis in the upper extremity. The incidence of thrombus was between the age of 60-102 years in the 35.8%.650 patients, the median age of 82 years, the average age of 81.5 + 9.3 years, the male 628 cases, the female 22 cases, and the male and female ratio 28.5:1. single factor. The results showed that the age and BMI of the patients in the thrombus group were significantly higher than those in the control group, and in the patients with thrombus group, there were malignant tumors, thrombus history, chronic renal insufficiency, recent surgical trauma history, left arm catheterization, and the proportion of patients with the PICC tube tip in the innominate vein or subclavian vein was significantly higher than that in the control group, while the right arm was placed in the control group. The proportion of the PICC tube tip in the superior vena cava was higher than that in the thrombus group, P0.05. The results of logistic multivariate regression analysis showed that age, chronic renal insufficiency and recent surgical trauma history had statistical differences in many factors, such as sex, age, BMI, chronic renal insufficiency, recent surgical trauma history, intubation arm, PICC tube tip position, and so on. These three factors are independent risk factors for thrombus formation after PICC catheterization in elderly patients. Conclusion: 1. single factor analysis results show that the risk factors of thrombosis in elderly patients after PICC catheterization are age, BMI, malignant tumor, thrombus history, chronic renal insufficiency, recent surgical trauma history, intubation arm, and PICC tube tip position.2. Logistic multivariate regression analysis showed that age, chronic renal insufficiency and recent surgical trauma history were independent risk factors for thrombus formation in elderly patients after PICC catheterization. Objective: To study the therapeutic effect of PICC catheter related deep venous thrombosis in elderly patients and its influence factors. Methods: select our hospital from January 2008 to 2013 12 126 cases of PICC related upper limb deep venous thrombosis were diagnosed in the month. The general data of the patients, the history of the basic disease, the related information of the catheter, the data of thrombus related, whether the catheter was removed, the results of ultrasound follow-up and the antithrombotic treatment were established and the database was established, and then the results were statistically analyzed. The statistical software applied SPSS20.0 Software package. Statistical methods include: single factor analysis using chi square test and t test, cumulative recurrence rate using Kaplan-Meier analysis, all statistical results are P0.05 as a significant test level. Results: 126 cases of male 116 cases, female 10 cases, average age 86.8 + 6.3 years (69-99 years), among them 49 cases of symptomatic thrombus (38.9%), There were 77 cases (61.1%) of asymptomatic thrombus, including upper limb edema (32 cases), pain (11 cases), and pain accompanied by edema (6 cases). The average time of the upper limb deep vein thrombosis was 52.2 + 72.1 days, the shortest 7 days, and the longest 379 days. 100 patients received thrombolytic therapy, 26 antithrombotic treatment and antithrombotic therapy were found. The average days were 35.4 + 5 days, the shortest 7 days and the longest 279 days. The thrombus was completely re passed in 66 cases, 21 cases were re passed, 24 cases without change, and 15 cases of thrombus progression. According to the effect of antithrombotic therapy, the patients were divided into the re group and the failure group. The general data of the patients were compared with the basic disease conditions, and the results showed that the levels of the factors among the two groups were all level. There was no significant difference in Statistics (P0.05). The catheter related information of two groups of patients, including the number of catheterization days, the placement of the tube arm, whether the catheter was removed, whether the thrombolytic therapy and the thrombus were accepted, was compared. The results showed that the ratio of the catheter removal and the antithrombotic treatment was significantly higher in the patients in the re group than in the failure group, and the two groups were statistically poor. The rate of complete recanalization of deep vein thrombosis in the upper extremity was significantly higher than that in patients without catheterization (63.7%vs22.9%). The total recanalization rate and partial recanalization rate of the upper limb deep vein thrombosis in patients receiving antithrombotic therapy were 62% and 20% respectively, significantly higher than the complete recanalization rate and partial recanalization rate in patients who had not received antithrombotic therapy. The results of 15.4% and 3.8%.Kaplan-Meier analysis showed that the cumulative recanalization rate of the thrombolytic catheter group and the antithrombotic treatment group was significantly higher than that of the unpulled catheter group and the untreated group. P0.05. conclusion: the treatment of the 1. PICC catheter related upper limb deep vein thrombosis and the removal of the catheter and the treatment of antithrombotic therapy The effect of thrombus therapy was better in the patients who had been removed and treated with antithrombotic therapy. The age, sex, BMI, BMI, the history of basic disease, the number of intubation arms, the number of catheterization and the position of thrombus were not significantly related to the treatment effect of the PICC catheter related upper limb deep vein thrombosis; 3. when the PICC tube related thrombus was found, extubation and antithrombotic treatment were the same It is important, but the opportunity for a new location after extubation leads to an increased chance of a recurrence of thrombus. Therefore, for the elderly patients with no serious symptoms, the catheter is still useful, and there is no sign of infection in the elderly, we advocate the retention of the catheterization. This conclusion helps to simplify and clarify the process of PICC catheter related thrombus treatment and provide clear clinical work. Guidance.
【學位授予單位】：中國人民解放軍醫(yī)學院
【學位級別】：博士
【學位授予年份】：2015
【分類號】：R543.6

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