王娟 周江红 张彩琳 张薇 李婷

[摘要]化疗是外周 T 细胞淋巴瘤的一线治疗，输注化疗药物时输液选择外周置入中心静脉导管（PICC），置管期间导管相关性感染、血栓形成及菌血症等并发症发生率明显增加。本研究总结1例 T 细胞淋巴瘤 PICC 置管术后合并导管相关性血栓（CRT）、导管相关性血流感染（CRBSI）及菌血症的临床表现、发生过程及护理效果，给予抗感染、抗凝治疗，患肢抬高制动，穿刺处加强换药，密切观察病情，局部湿敷等措施，患者体温恢复正常，右上臂疼痛缓解，血培养阴性。通过对该病例的治疗护理和讨论分析，积累了对 PICC 患者 CRT、 CRBSI 及菌血症的预防及治疗护理经验。

[关键词]外周 T 细胞淋巴瘤; PICC 置管术; CRT; CRBSI;菌血症

[中图分类号] R733.1 [文献标识码] A  [文章编号]2095-0616（2021）22-0219-04

Complicated CRT， CRBSI and bacteraemia after PICC placement in patients with peripheral T-cell lymphoma

WANG  Juan1    ZHOU  Jianghong2    ZHANG  Cailin3    ZHANG  Wei3    LI  Ting3            1.Department of Head and Neck Surgery Ⅱ ， Gansu Provincial Cancer Hospital， Gansu， Lanzhou 730050， China;2.Department of Nursing， Gansu Provincial Cancer Hospital， Gansu， Lanzhou 730050， China;3.Department of Hematology， Gansu Provincial Cancer Hospital， Gansu， Lanzhou 730050， China

[Abstract] Although chemotherapy is the first-line treatment for peripheral T-cell lymphoma， if peripherauy inserted central catheter （PICC） is chosen for infusion of chemotherapeutic drugs， the incidence of complications such as catheter-related infection， thrombosis and bacteremia increases significantly during the placement. In this study， the clinical manifestations， course of occurrence and nursing effect of complicated catheter-related thrombosis （CRT）， catheter-related bloodstream infection （CRBSI） and bacteraemia after PICC placement in one patient with T-cell lymphoma were summarized. This patient was given anti-infection and anticoagulation treatment， had the affected limb fixed with suspension braking， and received more frequent dressing change at the puncture site， close observation of the condition， and local wet compresses. After that， the patient's body temperature returned to normal， the pain in the right upper arm was relieved， and the blood culture was negative. Through discussing and analyzing the treatment and nursing for this patient， experience in the prevention， treatment and nursing of patients with CRT， CRBSI and bacteraemia after PICC placement was accumulated.

[Key words] Peripheral T-cell lymphoma; Peripherauy inserted central catheter placement; Catheter-related thrombosis; Catheter-related bloodstream infection; Bacteraemia

外周 T 細胞淋巴瘤（peripheral T-cell lymphoma， PTCL）是一组起源于胸腺后成熟 T 细胞或 NK/T 细胞的高度异质性的侵袭性非霍奇金淋巴瘤，经外周置入中心静脉导管（peripherally inserted central catheter， PICC）是 PTCL 输入化疗药物的首选静脉通路，导管相关性血流感染（catheter related blood stream infections， CRBSI）及导管相关性血栓（catheter related thrombosis， CRT）是 PICC 置管后最严重的两大并发症，显著增加患者住院时间及医疗费用。本文对1例 PTCL 患者 PICC 置管术后合并 CRT、CRBSI 的病例报道如下。

1案例分析

患者，女，62岁，2015年开始无明显诱因出现全身皮肤瘙痒，曾就诊多家医院，多部位皮肤活检（耻骨联合、股外侧、腹部、右眼外眦旁）均为良性病变，诊断为湿疹，给予激素等治疗，皮肤瘙痒时轻时重及反复发作。2020年3月27日患者因“反复皮肤瘙痒5年余，发现淋巴结肿大3月”就诊于兰州市第一人民医院，行右颈部肿大淋巴结活检术，诊断为 PTCL。……