出血性脑卒中患者PICC深静脉血栓形成的影响因素分析

摘要/Abstract

摘要： 目的了解出血性脑卒中患者经外周静脉置入中心静脉导管（Peripherally Inserted Central Catheters,PICC）置管后深静脉血栓形成的影响因素。方法本研究采用回顾性分析方法,选取2021年1月—2023年12月常德市第一人民医院收治的235例行PICC的出血性脑卒中患者的临床资料。根据深静脉血栓是否形成分为发生组（n=34）和未发生组（n=201）,分析两组患者年龄、性别、置管时Wells评分、置管时Caprini评分、置管时格拉斯哥昏迷量表（Glasgow Coma Scale,GCS）评分、置管部位肌力、置管前D-二聚体、置管前血浆纤维蛋白原、置管前凝血酶时间,置管后动态复查四肢深静脉彩超。结果 235例出血性脑卒中患者行PICC置管后34例形成深静脉血栓,发生率为14.5%;两组患者性别、置管时Caprini评分、置管时GCS评分、置管部位肌力、置管前血浆纤维蛋白原、置管前凝血酶时间比较,差异均无统计学意义（P>0.05）;两组患者年龄、置管时Wells评分、置管前D-二聚体比较,差异有统计学意义（P<0.05）。结论年龄过高、置管时Wells评分低、置管前D-二聚体水平高会增加出血性脑卒中患者PICC置管后相关性静脉血栓的发生率,对于此类患者置管后应该积极预防深静脉血栓的发生,及时动态复查四肢深静脉彩超,必要时予以深静脉置管代替PICC。

关键词: 出血性脑卒中, PICC相关性静脉血栓, 临床特点

Abstract: Objective Understand the influencing factors of deep vein thrombosis in patients with hemorrhagic stroke after PICC catheterization. Methods This study used a retrospective analysis method to analyze the clinical data of 235 PICC patients with hemorrhagic stroke admitted to the First People's Hospital of Changde City from January 2021 to December 2023. According to the formation of deep vein thrombosis, patients were divided into two groups: occurrence group (34 cases) and non occurrence group (201 cases). The age, gender, Wells score at catheterization, Caprini score at catheterization, Glasgow Coma Scale (GCS) score at catheterization, muscle strength at catheterization site, D-dimer before catheterization, plasma fibrinogen before catheterization, and thrombin time before catheterization were analyzed for both groups. Four limb deep vein ultrasound was dynamically re examined after catheterization. Results Among 235 patients with hemorrhagic stroke, 34 developed deep vein thrombosis after PICC catheterization, with an incidence rate of 14.5%; There was no statistically significant difference between the two groups in terms of patient gender, Caprini score at catheterization, GCS score at catheterization, muscle strength at catheterization site, plasma fibrinogen before catheterization, and thrombin time before catheterization (P>0.05); There were statistically significant differences between the two groups in patient age, Wells score at catheterization, and D-dimer before catheterization (P<0.05). Conclusion Being too old, having a low Wells score during catheterization, and having high levels of D-dimer before catheterization can increase the incidence of related venous thrombosis in patients with hemorrhagic stroke after PICC catheterization. For such patients, active prevention of deep vein thrombosis should be taken after catheterization, and dynamic ultrasound examinations of the deep veins in the limbs should be conducted in a timely manner. If necessary, deep vein catheterization should be used instead of PICC.

Key words: Hemorrhagic stroke, PICC-associated venous thrombosis, Clinical features

中图分类号:

R743.3

唐艳丽, 陈剑琴. 出血性脑卒中患者PICC深静脉血栓形成的影响因素分析[J]. 中华养生保健, 2025, 43(7): 119-122.

TANG Yan-li, CHEN Jian-qin. Analysis of Influencing Factors on PICC Deep Vein Thrombosis in Patients with Hemorrhagic Stroke[J]. ZHONGHUA YANGSHENG BAOJIAN, 2025, 43(7): 119-122.

参考文献

[1] 中心静脉血管通路装置安全管理专家组.中心静脉血管通路装置安全管理专家共识(2019版)[J].中华外科杂志,2020,58(4):261-272.
[2] WALKER G, TODD A.Nurse-led PICC insertion: is it cost effective[J]. Br J Nurs 2013,22(19):S9-S15.
[3] VIDAL V, MULLER C, JACQUIER A, et al.Prospective evaluation of PICC line related complications[J].J Radiol,2008,89(4):495-498.
[4] VERSO M, AGNELLI G.Venous thromboembolism associated with long-term use of centralvenous catheters in cancer patients[J]. J Clin Oncol, 2003, 21(19): 3665-3675.
[5] CORTELEZZIA A, FRACCHIOLLA N S, MAISONNEUVE P, et al.Central venous catheter-relatedcomplications in patients with hematological malignancies: a retrospective analysis of riskfactors and prophylactic measures[J].Leuk Lymphoma, 2003,44(9):1495-1501
[6] AW A, CARRIER M, KOCZERGINSKI J, et al.Incidence and predictive factors of symptomaticthrombosis related to peripherally inserted central catheters in chemotherapy patients[J].Thromb Res,2012,130(3):323-326.
[7] 蔡秀群,李懿. 罕见PICC 继发性异位致深静脉血栓合并颅内静脉窦血栓形成[J]. 中国医学创新,2014,11(26):133-135.
[8] 周翠丽. 脑出血开颅术后预防下肢深静脉血栓的护理[J].中国城乡企业卫生,2020,35(11):219-220.
[9] SCOLARO J A, TAYLOR R M, WIGNER N A.Venous thromboembolism in orthopaedic trauma[J]. J Am Acad Orthop Surg, 2015,23(1):1-6.
[10] WELLS P S, ANDERSON D R, BORMANIS J, et al.Value of assessment of pretest probability of deep-vein thrombosis in clinical management[J]. Lancet, 1997, 350(9094): 1795-1798.
[11] MODI S, DEISLER R, GOZEL K, et al.Wells criteria for DVT is a reliable clinical tool to assess the risk of deep venous thrombosis in trauma patients[J]. World J Emerg Surg, 2016 ,11:24.
[12] BAHL VHU HMHENKE P K, et al. A validation study of a retrospective venous t-hromboembolism risk scoring method[J].Ann Surg,2010,251(2):344-350.
[13] LI S, WANG L, LU Q.Comparison of the predictive power of the 2005 and 2010 Caprini risk assessment models for deep vein thrombosis in Chinese orthopedic patients at admission: A prospective cohort study[J]. Thromb Res, 2023,222:1-6.
[14] MIDDLETON P M.Practical use of the Glasgow Coma Scale; a comprehensive narrative review of GCS methodology[J]. Australas Emerg Nurs J, 2012,15(3):170-183.
[15] LIU M, LIU L, HUANG F, et a1. Perioperative treatment of femoral neck fracture with deep venous thrombosis: A case report[J].Chin Traumatol, 2015,18(2):109-112.
[16] SARAGAS N P, FERRAO P N, JACOBSON B F, et al.The benefit of pharmacological venous thromboprophylaxis in foot and ankle surgery[J]. S Afr Med J, 2017,107(4):327-330.
[17] LI Q, YU Z, CHEN X, et a1. Risk factors for deep venous thrombosis of lower limbs in postoperative neurosurgical patients[J]. Med Sci, 2016,32(5):1107-1110.
[18] 黄海星,陈冰玲,林玉璇.医用压力袜预防ICU危重病人下肢深静脉血栓形成的护理研究[J].当代医学,2013,19(16):113-114.
[19] 程华斌. 丹参川芎嗪联合低分子肝素预防下肢骨折术后深静脉血栓形成的临床疗效[J].中国社区医师,2016,32(7):99-100.
[20] 高苗,冯娜,左秀萍,等.预防性护理对肺癌患者治疗后深静脉血栓形成率的临床效果:A meta-analysis[J].海南医学院学报,2020,26(8):618-623.
[21] 叶瑞,杨亚娟,屈娟,等.下肢深静脉血栓的观察及护理[J].心血管外科杂志(电子版),2019,8(3):190.
[22] NICOL M, SUN Y, CRAIG N, et al.Incidence of thromboembolic complications in lumbar spinal surgery in 1,111 patients[J]. Eur Spine,2009,18(10):1548-1552.
[23] 王凤卿,李静.早期活动对预防脑出血患者下肢深静脉血栓形成的作用[J].中国农村卫生,2016,(18):75-76.
[24] LANGE N, MÉAN M, STALDER O, et al. Anticoagulation quality and clinical outcomes in multimorbid elderly patients with acute venous thromboembolism[J]. Thromb Res, 2019,177:10-16.
[25] STöRMANN P, OSINLOYE W, FREIMAN T M, et al. Early Chemical Thromboprophylaxis Does not Increase the Risk of Intracranial Hematoma Progression in Patients with Isolated Severe Traumatic Brain Injury[J]. World J Surg, 2019,43(11):2804-2811.
[26] STöRMANN P, OSINLOYE W, VERBOKET R D, et al. Early start of thromboprophylaxis does not increase risk of intracranial hematoma progression in multiply injured patients with traumatic brain injury[J]. Brain Inj, 2022,36(8):1046-1052.
[27] FOREMAN P M, SCHMALZ P G, GRIESSENAUER C J.Chemoprophylaxis for venous thromboembolism in traumatic brain injury: a review and evidence-based protocol[J]. Clin Neurol Neurosurg, 2014,123:109-116.
[28] 戴潇. 癌症导管相关深静脉血栓形成预测模型的建立及外部验证[D].昆明:昆明医科大学,2023.
[29] 马军,秦叔逵,吴一龙,等.肿瘤相关静脉血栓栓塞症预防与治疗指南(2019版)[J].中国肿瘤临床,2019,46(13):653-660.
[30] 谭雍,潘湘涛.恶性血液肿瘤相关静脉血栓栓塞症的研究进展[J].临床医学研究与实践,2020,5(28):195-198.
[31] DIAZ QUINTERO L A, FUENTES H E, et al. Pancreatic cancer thromboembolic outcomes: rate of thrombosis after adenocarcinoma and non-adenocarcinoma pancreatic cancer surgery[J]. Int Angiol, 2019,38(3):194-200.
[32] STOKOWSKI G,STEELE D,WILSON D.The use of ultrasound to improve practice and reduce complication rates in peripherally inserted central catheter insertions:final report of investigation[J]. J Infus Nurs,2009,32(3):145-155.
[33] 关海天,黄剑,等.超声引导下使用改良塞丁格技术行PICC置管临床研究[J].世界最新医学信息文摘,2019,19(26):130-131.