癌症患者中心静脉导管相关性血栓现状及危险因素meta分析

摘要/Abstract

摘要： 目的分析癌症患者中心静脉导管相关性血栓的现状及危险因素。方法检索PubMed、Web of Science、Cochrane Library、CNKI、万方、CBM和EBSCO等数据库中有关癌症患者中心静脉导管相关性血栓独立危险因素的相关文章,检索时间从建库至2022年5月,合并结局指标,Meta分析使用RevMan5.3软件。结果 17篇文献纳入,共10 628例患者,导管相关性血栓的人数为832例,感染发生率为7.82%,危险因素有10项。分析独立危险因素的OR值及95%CI,年龄>60岁（OR=2.73,95%CI为2.62~2.84）、二次调整导管位置（OR=2.93,95%CI为1.94~4.41）、导管类型（OR=2.08,95%CI为1.58~2.73）、导管异位（OR=2.64,95%CI为2.00~3.48）、D-二聚体水平（OR=1.18,95%CI为1.10~1.27）、肿瘤分期（tumor mode metastasis,TNM分期）为晚期（OR=3.07,95%CI为2.25~4.18）、化疗（OR=2.40,95%CI为1.59~3.62）、肿瘤部位（OR=3.14,95%CI为2.09~4.74）、患者合并糖尿病（OR=2.60,95%CI为1.65~4.09）、既往有导管相关性血栓病史（OR=4.03,95%CI为1.69~9.61）,各组差异均有统计学意义（均P<0.05）。结论年龄>60岁、二次调整导管位置、导管类型、导管异位、D-二聚体水平较高、TNM分期为晚期、化疗、肿瘤部位、既往有导管相关性血栓病史、合并糖尿病是癌症患者发生中心静脉导管相关性血栓的独立危险因素。临床上重视高危人群和相关危险因素,采取有效的干预措施,降低中心导管相关性血栓的发生。

关键词: 导管相关性血栓, 癌症, meta分析, 危险因素

Abstract: Objective To analyze the status and risk factors of central venous catheter-related thrombosis in cancer patients.Methods The related articles on independent risk factors for central venous catheter-related thrombosis in cancer patients were searched in PubMed,Web of Science,Cochrane Library,CNKI,Wanfang,CBM,EBSCO and other databases,which were retrieved from database establishment to May 2022. The outcome measures were combined and meta-analysis was performed using RevMan5.3 software. Results A total of 10 628 patients were included in 17 literatures,including 832 cases of catheter-related thrombosis,the infection rate was 7.82% and there were 10 risk factors. The OR value and 95%CI of independent risk factors were analyzed：age >60 years old（OR=2.73,95%CI：2.62-2.84）,secondary adjustment of catheter position（OR=2.93,95%CI：1.94-4.41）,catheter type（OR=2.08,95%CI：1.58-2.73）,ectopic catheter（OR=2.64,95%CI：2.00-3.48）,D-dimer level（OR=1.18,95%CI：1.10-1.27）,tumor mode metastasis（TNM） was late stage（OR=3.07,95%CI：2.25-4.18）,chemotherapy（OR=2.40,95%CI：1.59-3.62）,tumor site（OR=3.14,95%CI：2.09-4.74）,combined diabetes（OR=2.60,95%CI：1.65-4.09）,previous history of catheter-related thrombosis（OR=4.03,95%CI：1.69-9.61）,and the difference was statistically significant among all groups（P<0.05）. Conclusions Age>60 years old,secondary catheter position adjustment,catheter type,catheter ectopic,higher D-dimer level,advanced TNM stage,chemotherapy,tumor site,previous history of catheter-related thrombosis,and combined diabetes are independent risk factors forcentral venous catheter-related thrombosis in cancer patients. Clinically,attention should be paid to high-risk groups and related risk factors,and effective intervention measures should be taken to reduce the occurrence of central catheter-related thrombosis

Key words: Catheter-related thrombosis, Cancer, Meta analysis, Risk factors

中图分类号:

R181.2

王道新, 刘楠, 师泽元, 彭会珍, 关宁笑, 赵文利. 癌症患者中心静脉导管相关性血栓现状及危险因素meta分析. [J]职业与健康, 2023, 39(21): 3004-3010.

WANG Daoxin, LIU Nan, SHI Zeyuan, PENG Huizhen, GUAN Ningxiao, ZHAO Wenli. Status and risk factors of central venous catheter-related thrombosis in cancer patients：A meta-analysis. [J]OCCUPATION AND HEALTH, 2023, 39(21): 3004-3010.

参考文献

[1] 成芳,傅麒宁,何佩仪,等.输液导管相关静脉血栓形成防治中国专家共识(2020版)[J].中国实用外科杂志,2020,40(4):377-383.
[2] CHOPRA V,KUHN L,RATZ D,et al.Peripherally inserted central catheter-related deep vein thrombosis:contemporary patterns and predictors:reply[J].J Thromb Haemost,2014,12(11):1944-1947.
[3] CHEN Y,CHEN H,YANG J,et al.Patterns and risk factors of peripherally inserted central venous catheter-related symptomatic thrombosis events in patients with malignant tumors receiving chemotherapy[J]. J Vasc Surg Venous Lymphat Disord,2020,8(6):919-929.
[4] LIN Y,ZENG Z,LIN R,et al.The Caprini thrombosis risk model predicts the risk of peripherally inserted central catheter-related upper extremity venous thrombosis in patients with cancer[J].J Vasc Surg Venous Lymphat Disord,2021,9(5):1151-1158.
[5] WANG G D,WANG H Z,SHEN Y F,et al.The influence of venous characteristics on peripherally inserted central catheter-related symptomatic venous thrombosis in cancer patients[J].Cancer Manag Res,2020, 12:11909-11920.
[6] KANG J,SUN W,LI H,et al.Peripherally inserted central catheter-related vein thrombosis in breast cancer patients[J].J Vasc Access,2016, 17(1):67-71.
[7] KANG J R,LONG L H,YAN S W,et al.Peripherally inserted central catheter-related vein thrombosis in patients with lung cancer[J].Clin Appl Thromb Hemost,2017,23(2):181-186.
[8] KANG J,CHEN W,SUN W,et al.Peripherally inserted central catheter-related complications in cancer patients: A prospective study of over 50,000 catheter days[J].J Vasc Access,2017,18(2):153-157.
[9] AW A,CARRIER M,KOCZERGINSKI J,et al.Incidence and predictive factors of symptomatic thrombosis relatedto peripherally inserted central catheters in chemotherapy patients[J].Thromb Res,2012,130(3):323-326.
[10] SHI Y,WEN L,ZHOU Y,et al.Thrombotic risk factors in patients undergoing chemotherapy via peripherally inserted central catheter[J].J Int Med Res,2014,42(3):863-869.
[11] CHEN P,WAN G,ZHU B.Incidence and risk factors of symptomatic thrombosis related to peripherally inserted central catheter in patients with lung cancer[J].J Adv Nurs,2021,77(3):1284-1292.
[12] Al-ASABI O,ALMUSARHED M,ELDEEB H.Predictive risk factors of venous thromboembolism(VTE) associated with peripherally inserted central catheters(PICC) in ambulant solid cancer patients:Retrospective single Centre cohort study[J].Thromb J,2019,17:2.
[13] 刘斌亮,谢俊英,王延风,等.乳腺癌患者中心静脉置管导管相关性血栓的发生情况及其影响因素[J].中华肿瘤杂志,2021,43(8):838-842.
[14] 裘成莉,潘巧玲,徐国栋,等.食管癌化疗患者置入中心静脉导管相关性血栓的危险因素分析[J].中华全科医学,2018,16(9):1566-1569.
[15] 樊孟涛. 食管癌术后中心静脉导管相关性血栓发生情况及危险因素分析[D].郑州:郑州大学,2021.
[16] 李萍,闫虹,李雅琪,等.恶性肿瘤同步放化疗患者不同置管方式导管相关性静脉血栓的发生率及危险因素分析[J].中国临床医生杂志,2021,49(10):1200-1203.
[17] 郭华,尚勤燕,胡晓静,等.淋巴瘤化疗患者经外周静脉置入中心静脉导管相关性静脉血栓的危险因素分析[J].中华现代护理杂志,2022,28(8):1080-1083.
[18] 郑美花,黄凤凤,王璐祯.同步放化疗患者PICC相关性静脉血栓形成影响因素分析[J].中华肿瘤防治杂志,2019,26(21):1637-1641.
[19] 马瑞娟,张丽萍,李娅,王玉,窦昊颖,张春梅.中国老年人居家不出发生率及影响因素的meta分析[J].职业与康,2022,38(12):1697-1701.
[20] 张晓霞,胡秀英.PICC相关性静脉血栓风险预测模型的研究进展[J].中华现代护理杂志,2022,28(12):1541-1546.
[21] 陈抒婕,张京慧,候剑媚,等.不同模式踝泵运动预防肺癌患者股静脉PICC置管导管相关性血栓的效果[J].中华现代护理杂志,2022, 28(12):1547-1551.
[22] 鞠阳,张茵英,周菊珍,等.智能握力系统在PICC患者功能锻炼中的应用[J].中华护理杂志,2021,56(8):1169-1173.
[23] 王宁,郭振江,张媛媛,等.危重症患者中心静脉导管相关性血栓危险因素分析及列线图预测模型的建立[J].中华危重病急救医学,2021, 33(9):1047-1051.
[24] PU Y L,LI Z S,ZHI X X,et al.Complications and costs of peripherally inserted central venous catheters compared with implantable port catheters for cancer patients:a meta-analysis[J].Cancer Nurs,2020, 43(6):455-467.
[25] MIELKE N,JOHNSON S,KARABON P,et al.A prospective sonographic evaluation of peripheral intravenous catheter associated thrombophlebitis[J].J Vasc Access,2022,23(5):754-763.
[26] ELLIS M L,OKANO S,MCCANN A,et al.Catheter-related thrombosis incidence and risk factors in adult cancer patients with central venous access devices[J].Intern Med J,2020,50(12):1475-1482.
[27] LIU G D,MA W J,LIU H X,et al.Risk factors associated with catheter-related venous thrombosis:A meta-analysis[J].Public Health,2022, 205:45-54.
[28] TURRIAN U,LAPEBIE F X,BURA-RIVIERE A.Duration of anticoagulation for upper extremity deep vein thrombosis associated with cancer and central venous catheter:Outcome of a cohort study[J].J Med Vasc,2022,47(1):11-18.
[29] CLARK J R,HOFFMAN S C,SHLOBIN N A,et al.Incidence of catheter-associated right atrial thrombus detected by transthoracic echocardiogram[J].Echocardiography,2021,38(3):435-439.
[30] BAHHI A,DILORETO E,JANKOWSKI D,et al.Comparison of 2 midline catheter devices with differing antithrombogenic mechanisms for catheter-related thrombosis:A randomized clinical trial[J].JAMA Netw Open,2021,4(10):e2127836.
[31] INGRAM P R,KILGARRIFF S,GRZELAK M,et al.Risk factors for catheter related thrombosis during outpatient parenteral antimicrobial therapy[J].J Vasc Access,2021:919204689.
[32] 顾婕,钱火红,黄建业,等.2021年美国输液护理学会《输液治疗实践标准》——血管通路装置并发症的解读[J].解放军护理杂志,2022,39(1):90-93.
[33] BAUMANN KREUZIGER L,GADDH M,ONADEKO O,et al.Treatment of catheter-related thrombosis in patients with hematologic malignancies:A Venous thromboEmbolism Network U.S.retrospective cohort study[J].Thromb Res,2021,202:155-161.
[34] GORSKI L A,HADAWAY L,HAGLE M E,et al.Infusion therapy standards of practice,8th edition[J].J Infus Nurs,2021,44(1S Suppl 1):S1-S224.
[35] ESTRADA-OROZCO K,CANTOR-CRUZ F,LARROTTA-CASTILLO D,et al.Central venous catheter insertion and maintenance:Evidence-based clinical recommendations[J].Rev Colomb Obstet Ginecol,2020, 71(2):115-162.
[36] JAVERI Y,JAGATHKAR G,DIXIT S,et al.Indian society of critical care medicine position statement for central venous catheterization and management 2020[J].Indian J Crit Care Med,2020,24(Suppl 1):S6-S30.
[37] BHARGAVA M,BROCCARD S,BAI Y,et al.Risk factors for peripherally inserted central catheter line-related deep venous thrombosis in critically ill intensive care unit patients[J].SAGE Open Med,2020,8:2108001238.