婦科化學治療患者經外周靜脈置入中心靜脈導管并發癥原因分析_West China Medical Journal

Authors：

李德華 ¹ , 何亞林 ² , 明先 ² , 劉華瓊 ² , 鄧利容 ² , 龍德蓉 ²

1. ;
2. ;

Corresponding?author：

龍德蓉, Email:

Keywords：

經外周靜脈置入中心靜脈導管; 婦科化療; 并發癥

DOI：

10.7507/1002-0179.201701022

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目的探討婦科行化學治療（化療）患者經外周靜脈置入中心靜脈導管（peripherally inserted central catheter，PICC）并發癥的影響因素。方法收集 2015 年 6 月—2016 年 6 月接受化療并需要置入 PICC 的婦科腫瘤患者。觀察患者并發癥、拔管原因、導管頭端位置、穿刺次數、置管部位、置管時間及拔管時間。結果 920 例患者成功接受 PICC 置管，其中隨訪中死亡 25 例，失訪 83 例。104 例患者因并發癥而提前拔管，其 PICC 留置時間中位數為 62 d，并發癥以靜脈炎[41.35%（43/104）]和血栓形成[25.96%（27/104）] 最常見。左上肢置管[12.68%（53/418）]與右上肢置管[12.94%（51/394）]的并發癥發生率比較差異無統計學意義（χ²=0.013，P>0.05），肘前窩靜脈置管[12.95%（72/556）] 與上臂靜脈置管[12.50%（32/256）] 的并發癥發生率比較差異無統計學意義（χ²=0.032，P>0.05）。導管頭端位于非上腔靜脈者[28.57%（8/28）] 較位于上腔靜脈者[12.24%（96/784）] 并發癥發生率更高，多次（≥2次）穿刺者[30.19%（16/53）] 較 1 次穿刺成功者[11.59%（88/759）] 并發癥發生率更高，差異均有統計學意義（χ²=5.074、15.338，P<0.05）。結論婦科化療患者 PICC 置管后并發癥較常見。但 PICC 仍是一種較安全、經濟、能家庭護理的靜脈通路。

Citation： 李德華, 何亞林, 明先, 劉華瓊, 鄧利容, 龍德蓉. 婦科化學治療患者經外周靜脈置入中心靜脈導管并發癥原因分析. West China Medical Journal, 2017, 32(9): 1427-1429. doi: 10.7507/1002-0179.201701022 Copy

1.	Hadaway LC. Major thrombotic and nonthrombotic complications. Loss of patency. J Intraven Nur, 1998, 21(5 Suppl): S143-S160.
2.	鄭春輝, 王鳳, 陳強譜. 經外周穿刺置入中心靜脈導管的并發癥及防治. 中華護理雜志, 2004, 39(9): 700-702.
3.	王秀榮, 蔣朱明, 馬恩陵. 640 例經外周靜脈置入中心靜脈導管的回顧. 中國臨床營養雜志, 2002, 10(2): 133-134.
4.	王亞麗. PICC 與 CVC 在胃腸外營養治療中的應用效果對比. 醫療裝備, 2017, 30(12): 147-148.
5.	DG Maki. Infections caused by intravascular devices used for infusion therapy: pathogenesis, prevention, and management. Infections associated with indwelling medical devices. 2nd ed. Washington: American Society for Microbiology, 1994, 2: 155-212.
6.	黎玉國, 蔣朱明. 腸外營養新途徑 (PICC 技術). 中國臨床營養雜志, 2000, 8(3): 181-183.
7.	Goodwin ML, Carlson I. The peripherally inserted central catheter: a retrospective look at three years of insertions. J Intraven Nurs, 1993, 16(2): 92-103.
8.	Loughran SC, Borzatta M. Peripherally inserted central catheters: a report of 2506 catheter days. JPEN J Parenter Enteral Nutr, 1995, 19(2): 133-136.
9.	Loewenthal MR, Dobson PM, Starkey RE, et al. The peripherally inserted central catheter (PICC): a prospective study of its natural history after cubital fossa insertion. Anaesth Intensive Care, 2002, 30(1): 21-24.
10.	Monreal M, Quilez F, Rey-Joly C, et al. Infusion phlebitis in patients with acute pneumonia: a prospective study. Chest, 1999, 115(6): 1576-1580.
11.	James L, Bledsoe L, Hadaway LC. A retrospective look at tip location and complications of peripherally inserted central catheter lines. J Intraven Nurs, 1993, 16(2): 104-109.
12.	Montalto M. How safe is hospital-in-the-home care?. Med J Aust, 1998, 168(6): 277-280.
13.	趙中月. 喜療妥用于 PICC 置管患者預防早期機械性靜脈炎的效果觀察. 中華現代護理學雜志, 2012.
14.	Thomas MV, Marc S, Sue M, et al. The diverse and conflicting standards and practices in infusion therapy. J Vascular Access Devices, 2002, 7(3): 9-25.
15.	劉小娜. 腫瘤化療患者留置 PICC 并發靜脈血栓的臨床護理. 遼寧醫學雜志, 2015(2): 113-114.
16.	Mermel LA. Prevention of intravascular catheter-related infections. Ann Intern Med, 2000, 132(5): 391-402.
17.	Moureau NL, Mckinnon BT, Claudia MD. Multidisciplinary management of thrombotic catheter occlusions in vascular access devices. J Vascular Access Devices, 1999, 4(2): 22-29.
18.	齊敏. PICC 和 CVC 置管技術在惡性腫瘤患者靜脈治療中的應用效果對比. 中國醫藥指南, 2015(35): 136-137.

1. Hadaway LC. Major thrombotic and nonthrombotic complications. Loss of patency. J Intraven Nur, 1998, 21(5 Suppl): S143-S160.
2. 鄭春輝, 王鳳, 陳強譜. 經外周穿刺置入中心靜脈導管的并發癥及防治. 中華護理雜志, 2004, 39(9): 700-702.
3. 王秀榮, 蔣朱明, 馬恩陵. 640 例經外周靜脈置入中心靜脈導管的回顧. 中國臨床營養雜志, 2002, 10(2): 133-134.
4. 王亞麗. PICC 與 CVC 在胃腸外營養治療中的應用效果對比. 醫療裝備, 2017, 30(12): 147-148.
5. DG Maki. Infections caused by intravascular devices used for infusion therapy: pathogenesis, prevention, and management. Infections associated with indwelling medical devices. 2nd ed. Washington: American Society for Microbiology, 1994, 2: 155-212.
6. 黎玉國, 蔣朱明. 腸外營養新途徑 (PICC 技術). 中國臨床營養雜志, 2000, 8(3): 181-183.
7. Goodwin ML, Carlson I. The peripherally inserted central catheter: a retrospective look at three years of insertions. J Intraven Nurs, 1993, 16(2): 92-103.
8. Loughran SC, Borzatta M. Peripherally inserted central catheters: a report of 2506 catheter days. JPEN J Parenter Enteral Nutr, 1995, 19(2): 133-136.
9. Loewenthal MR, Dobson PM, Starkey RE, et al. The peripherally inserted central catheter (PICC): a prospective study of its natural history after cubital fossa insertion. Anaesth Intensive Care, 2002, 30(1): 21-24.
10. Monreal M, Quilez F, Rey-Joly C, et al. Infusion phlebitis in patients with acute pneumonia: a prospective study. Chest, 1999, 115(6): 1576-1580.
11. James L, Bledsoe L, Hadaway LC. A retrospective look at tip location and complications of peripherally inserted central catheter lines. J Intraven Nurs, 1993, 16(2): 104-109.
12. Montalto M. How safe is hospital-in-the-home care?. Med J Aust, 1998, 168(6): 277-280.
13. 趙中月. 喜療妥用于 PICC 置管患者預防早期機械性靜脈炎的效果觀察. 中華現代護理學雜志, 2012.
14. Thomas MV, Marc S, Sue M, et al. The diverse and conflicting standards and practices in infusion therapy. J Vascular Access Devices, 2002, 7(3): 9-25.
15. 劉小娜. 腫瘤化療患者留置 PICC 并發靜脈血栓的臨床護理. 遼寧醫學雜志, 2015(2): 113-114.
16. Mermel LA. Prevention of intravascular catheter-related infections. Ann Intern Med, 2000, 132(5): 391-402.
17. Moureau NL, Mckinnon BT, Claudia MD. Multidisciplinary management of thrombotic catheter occlusions in vascular access devices. J Vascular Access Devices, 1999, 4(2): 22-29.
18. 齊敏. PICC 和 CVC 置管技術在惡性腫瘤患者靜脈治療中的應用效果對比. 中國醫藥指南, 2015(35): 136-137.

West China Medical Journal

婦科化學治療患者經外周靜脈置入中心靜脈導管并發癥原因分析

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