利伐沙班预防经外周静脉穿刺中心静脉置管相关上肢静脉血栓疗效探讨#br#

摘要：目的　探讨利伐沙班预防经外周静脉穿刺中心静脉置管（PICC）相关上肢静脉血栓（UEVT）的疗效。方法　选取应用PICC的肿瘤患者420例为研究对象，按随机数字表法分为对照组（211例）和试验组（209例）。所有患者行PICC后，对照组采用物理预防UEVT；试验组在物理预防的基础上，于置管当日接受口服利伐沙班（10 mg/d，每日1次，连续30 d）。比较2组在置管前1 d与置管后30 d凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、D-二聚体、纤维蛋白原（FIB）、置管侧腋静脉最大流速、UEVT发生率及其他不良事件发生率。结果　置管后30 d，2组PT、APTT及FIB差异无统计学意义，试验组D-二聚体低于对照组（P＜0.05）。试验组置管后30 d的腋静脉最大流速较置管前1 d差异无统计学意义，而对照组置管后30 d的腋静脉最大流速较置管前1 d降低（P＜0.01）。试验组UEVT发生率（2.87% vs. 8.53%）及其他不良事件发生率（1.91% vs.5.69%）均低于对照组（均P＜0.05）。结论　利伐沙班可有效改善PICC置管后的高凝状态和血流减慢，从而降低PICC相关UEVT的发生率以及治疗过程中其他不良事件的发生率。

he efficacy of rivaroxaban in preventing upper extremity venous thrombosis associated with peripherally inserted central catheter

Abstract: Objective　To investigate the efficacy of rivaroxaban in preventing upper extremity venous thrombosis (UEVT) associated with peripherally inserted central catheter (PICC). Methods　A total of 420 tumor patients with PICC in Hengshui People's Hospital from June 2018 to December 2020 were selected as the research subjects. According to random number table method, they were divided into the control group (n=211) and experimental group (n=209). After PICC catheterization, the control group was given physical prevention, and the experimental group was given rivaroxaban orally (10 mg/d, once a day, for 30 days) on the basis of physical prevention on the day after catheterization. Follow-up was conducted for 30 days to compare the prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, fibrinogen (FIB), maximum flow rate of axillary vein on the side of catheterization, incidence of UEVT and other adverse events 1 day before and 30 days after catheterization between the two groups. Results　There were no significant differences in PT, APTT and FIB 30 days after catheterization between the two groups. The D-dimer was lower in the experimental group than that of the control group (P＜0.05). There was no significant difference in the maximum flow velocity of axillary vein between 1 day before catheterization and 30 days after catheterization in the experimental group, while the maximum flow velocity of axillary vein was lower at 30 days after catheterization than that of 1 day before catheterizationthe in control group (P＜0.01). The incidence of UEVT and other adverse events were significantly lower in the experimental group (2.87% vs. 8.53%) than those in the control group (1.91% vs.5.69%, P＜0.05). Conclusion　Rivaroxaban can effectively improve the hypercoagulability and blood flow reduction after PICC catheterization, thus reducing the incidence of PICC-related UEVT and other adverse events during the treatment.