肿瘤病人PICC置入部位医用粘胶剂相关性皮肤损伤的多因素分析

目的:调查肿瘤病人经外周静脉置入中心静脉导管(PICC)置入部位医用粘胶剂相关性皮肤损伤(MARSI)发生情况,分析相关影响因素。方法:回顾性收集2020年9月1日—2020年11月1日某院静脉导管中心382例PICC置管肿瘤病人的住院病历临床资料,根据MARSI发生情况分为未发生MARSI组和发生MARSI组,采用单因素和多因素Logistic回归分析肿瘤病人PICC置入部位发生MARSI的危险因素。结果:发生MARSI 60例,发生率为15.71%(60/382);MARSI类型主要以接触性皮炎[61.67%(37/60)]及机械性损伤[28.33%(17/60)]为主。单因素分析显示,穿刺部位、敷料种类、更换频次及是否使用紫杉醇是肿瘤病人PICC置入部位发生MARSI的相关因素(P<0.05)。Logistic多因素回归分析显示,穿刺部位[OR=4.042,95%CI(1.914,8.539),P<0.05]、是否使用紫杉醇[OR=27.915,95%CI(12.852,60.634),P<0.05]以及更换频次[OR=2.896,95%CI(1.334,6.284),P<0.05]是肿瘤病人PICC置入部位发生MARSI的独立影响因素。结论:肿瘤病人PICC置入部位MARSI发生率高,发生类型以接触性皮炎及机械性损伤为主,透明敷料更换频率过高、肱二头肌内侧穿刺、使用紫杉醇是MARSI发生的危险因素。在PICC维护过程中应关注MARSI的危险因素及高危人群。

Multivariate analysis of medical adhesive-related skin injury at PICC implantation site in cancer patients

Objective:To investigate the occurrence of medical adhesive-related skin injuries(MARSI)in cancer patients at the placement site of peripherally inserted central catheter(PICC),and analyze the related influencing factors.Methods:Clinical data of inpatient medical records of 382 patients with PICC catheterization in the venous catheterization center of a hospital from September 1,2020 to November 1,2020 were retrospectively collected.The patients were divided into MARSI group and non-MARSI group according to the occurrence of MARSI.Univariate and multivariate logistic regression were used to analyze the risk factors of MARSI at PICC insertion site of cancer patients.Results:The incidence of MARSI was 15.71%(60/382),the main types of MARSI were contact dermatitis61.67%(37/60),and mechanical injuries28.33%(17/60).The univariate analysis showed that puncture site,type of dressing,frequency of replacement and whether paclitaxel was used were the related factors of MARSI at PICC implantation site in cancer patients(P<0.05).The multivariate logistic regression analysis showed that puncture site[OR=4.042,95%CI(1.914,8.539),P<0.05],whether paclitaxel was used[OR=27.915,95%CI(12.852,60.634),P<0.05]and frequency of replacement[OR=2.896,95%CI(1.334,6.284),P<0.05]were independent influencing factors of MARSI at PICC implantation site in cancer patients.Conclusions:The incidence of MARSI at PICC implantation site in cancer patients is high,and the main types of MARSI are contact dermatitis and mechanical injury.High frequency of transparent dressing replacement,puncture at the medial side of biceps brachii,and use of paclitaxel are risk factors of the occurrence of MARSI.During PICC maintenance,attention should be paid to MARSI risk factors and high-risk groups.