急性胰腺炎患者PICC置管相关性静脉血栓形成的高危因素分析与护理

目的 探讨急性胰腺炎患者PICC置管致上肢静脉血栓形成的高危因素,并归纳总结护理对策.方法 选择2015年2月至2016年1月我院消化内科留置PICC导管的急性胰腺炎患者368例,对发生PICC相关静脉血栓的13例患者进行回顾性研究,分析患者年龄、性别、置管静脉、置管肢体、疾病严重程度、D-二聚体(D-dimer,D-D)、凝血酶原时间(PT)、纤维蛋白原(FIB)值、部分活化凝血酶原时间(APTT)的改变与发生静脉血栓有无相关性及血栓形成的时间.结果 确诊静脉血栓13例患者,性别及年龄比较差异均无统计学意义(P＞0.05);轻、重型胰腺炎患者发生血栓比较,差异具有统计学意义(P＜0.01);置管静脉右头静脉发生血栓概率最高(37.5%),左、右上肢肘正中静脉血栓发生率分别为(12.0%、4.7%),左、右贵要静脉血栓发生率分别为(1.3%、0.6%);血栓形成患者PT高于血栓未形成患者,差异具有统计学意义(P＜0.05);血栓形成患者APTT、FIB、D-D均明显高于血栓未形成患者,差异具有统计学意义(P＜0.01);留置PICC置管后形成血栓的平均时间(12.6±7.8)d,血栓最早可发生在置管后第3~4天.结论 急性重症胰腺炎患者血液凝血、纤溶系统的改变及置管静脉的选择直接影响静脉血栓的形成,护理人员要加强PICC置管相关性静脉血栓的预防意识,置管前严格评估患者凝血指标,置管时选择合适的静脉,置管后进行综合护理干预,以降低PICC置管相关性静脉血栓的发生率,延长置管时间.

The high-risk factors and nursing of venous thrombosis caused by PICC catheter-re-lated on patients with acute pancreatitis

Objective To explore the high-risk factors of upper extremity venous thrombosis caused by PICC catheter on patients with acute pancreatitis, and sum up the nursing countermeasures. Methods A total of 368 cases of patients with acute pancreatitis gastroenterology indwelling PICC catheter from February 2015 to January 2016 in our hospi-tal were selected. 13 cases of patients with PICC-related venous thrombosis were studied retrospectively to analyze the age, gender, intravenous catheter, catheter body, disease severity, D-dimer ( D-D) , prothrombin time ( PT) , fibrino-gen ( FIB) value, and the relationship between APTT and the formation of thromboplastin venous thrombosis and the time for the formation of thrombosis. Results 13 patients were diagnosed as venous thrombosis, the differences of gender and age were not statistically significant (P＞0. 05). There was statistical significance in terms of the difference of thrombosis of mild and relatively severe pancreatitis patients ( P＜0. 01 ) . The highest rate of the formation of vein thrombosis was right cephalic (37. 5%) . The incidence of vein thrombosis caused by the left and right upper extremity median cubital was 12. 0% and 4. 7% respectively. The incidence of vein thrombosis caused by left right basilic vein thrombosis rates was 1. 3% and 0. 6% respectively. The PT of the patients with vein thrombosis was higher than that of the patients without vein thrombosis, and the difference was statistically significant (P＜0. 05). APTT, FIB , D-D of patients with thrombosis was significantly higher than that of the patients without vein thrombosis, and the difference was significant (P＜0. 01). The average time of the formation of thrombosis after indwelling PICC catheter was (12. 6±7. 8) days, thrombosis can oc-cur as early as 3 to 4 days after the first catheter. Conclusions The formation of the venous thrombosis is directly affected by the blood coagulation and the changes of the fibrinolysis system of the patients with severe acute pancreatitis. Nurses should strengthen the awareness of prevention for PICC catheter-related venous thrombosis. The patients' coagulation indi-cator is strictly assessed of before the catheter. The appropriate intravenous catheter is selected during the catheter. The comprehensive nursing intervention is conducted after the catheter to reduce the incidence of PICC catheter-related venous thrombosis and prolong the catheterization time.