原娜++王磊+武雪亮

[摘要] 目的 探討肺癌化疗患者经外周中心静脉置管术（PICC）相关性静脉血栓的发生率及危险因素。 方法 选取2014年1月～2015年1月河北北方学院附属第一医院住院的符合PICC置管要求的肺癌化疗患者157例，进行180 d的临床观察。根据多普勒超声结果确诊血栓形成。单因素分析和Logistic回归多因素分析年龄、性别、肿瘤类型、临床分期、治疗情况、合并症、置管静脉的选择、PICC置管时间和不同的化疗药物对肺癌化疗患者PICC相关性静脉血栓的影响。 结果 157例肺癌患者中17例（10.8%）发生症状性PICC相关性静脉血栓。根据是否发生静脉血栓分为血栓组与无血栓组。在血栓组与无血栓组比较，性别、临床分期、使用依托泊苷差异有统计学意义（P < 0.05），年龄、肿瘤类型、治疗情况、合并症、置管静脉的选择及PICC置管时间差异无统计学意义（P > 0.05）。多因素Logistic回归分析显示：肺癌化疗患者PICC置管后使用依托泊苷发生相关性静脉血栓的风险增加1.373倍，女性发生静脉血栓的风险是男性的1.219倍，肺癌ⅢB～Ⅳ期发生静脉血栓的风险是Ⅱ～ⅢA的4.347倍。 结论 性别、临床分期和依托泊苷的使用是肺癌化疗患者PICC相关性静脉血栓的危险因素。

[关键词] 肺癌；中心静脉置管；静脉血栓；化疗药物

[中图分类号] R734.2 [文献标识码] A [文章编号] 1673-7210（2017）09（b）-0086-05

Risk factors analysis of peripherally inserted central catheter associated thrombosis in lung cancer patients with chemotherapy

YUAN Na1 WANG Lei2 WU Xueliang3

1.Department of Radiotherapy， First Affiliated Hospital of Hebei North University， Hebei Province， Zhangjiakou 075000， China； 2.Department of Intensive Care Unit， First Affiliated Hospital of Hebei North University， Hebei Province， Zhangjiakou 075000， China； 3.Vascular Gland Surgery， First Affiliated Hospital of Hebei North University， Hebei Province， Zhangjiakou 075000， China

[Abstract] Objective To discuss the incidence rate and risk factors of peripherally inserted central catheter （PICC） related thrombosis in patients with lung cancer receiving chemotherapy. Methods From January 2014 to January 2015， in First Affiliated Hospital of Hebei North University， 157 patients with lung cancer receiving chemotherapy and PICC were selected and observed for 180 days. The diagnosis of thrombosis was based on Doppler Sonography. Age， gender， tumor type， clinical stage， treatment，c omplications， PICC catheter selection of vein， PICC catheter time， different chemotherapy drugs and the influence of PICC related thrombosis were analyzed by single factor and the multiple Logistic regression to study. Results Among 157 caces， 17 cases （10.8%） ocurred symptomatic PICC-related thrombosis. The patients were individed into PICC-related thrombosis group and no-PICC-related thrombosis group according into thrombosis occurrence. PICC-related thrombosis group and no-PICC-related thrombosis group were compared， the differences of gender， clinical stage， using Etoposide were statistically significant （P < 0.05）， the differences of the age， tumor type， treatment， complication， PICC catheter selection of vein and PICC catheter time were not statistically significant （P > 0.05）. the multiple Logistic regression analysis suggested that the risk of PICC related thrombosis with patients with lung cancer receiving of etoposide treatment increased 1.373 times， the risk of PICC related thrombosis in female was 1.219 times that in male，and the risk of ⅢB-Ⅳ stages was 4.347 times that ofⅡ-ⅢA stages. Conclusion The gender， clinical stages and using Etoposide are the risk factors in lung patients with PICC-related thrombosis.endprint

[Key words] Lung cancer； Peripherally inserted central catheter； Vein thrombosis； Chemical drugs

随着经外周中心静脉置管术（PICC）在恶性肿瘤患者中的广泛应用，随之而来的并发症也引起临床医师的关注，其中常见的并发症是PICC相关性静脉血栓。PICC相关性静脉血栓常伴有上肢深静脉血栓，严重可致肺栓塞，已成为造成恶性肿瘤静脉血栓的因素之一[1]。据报道，恶性肿瘤发生PICC相关性静脉血栓的概率为6%～15%，癌症相关性血栓在肺癌中的致死率上升为14%[2]，接受化疗的肺癌患者发生静脉血栓的概率为3%～30%[3]。……