急性白血病病人PICC穿刺點(diǎn)持續(xù)滲血及靜脈炎相關(guān)因素研究

1、急性白血病病人PICC穿刺點(diǎn)持續(xù)滲血及靜脈炎相關(guān)因素研究        【中文摘要】目的探討急性白血病病人留置PICC后穿刺點(diǎn)持續(xù)滲血的相關(guān)因素及留置PICC導(dǎo)致靜脈炎發(fā)生的主要危險(xiǎn)因素,為臨床醫(yī)護(hù)職員能夠采取有針對(duì)性的預(yù)防和護(hù)理措施提供科學(xué)依據(jù)。方法本研究分為兩部分,均采用調(diào)查研究中的病例-對(duì)照研究方法。第一部分:收集2007年11月至2008年10月在中國(guó)醫(yī)學(xué)科學(xué)院血液病研究所白血病科住院治療并初次使用PICC導(dǎo)管的急性白血病病人60例。進(jìn)組病人置進(jìn)PICC后連續(xù)觀察72小時(shí),根據(jù)滲血和持續(xù)滲血的評(píng)價(jià)標(biāo)準(zhǔn),72

2、小時(shí)后穿刺點(diǎn)還有滲血的病人進(jìn)滲血組,無滲血的病人進(jìn)對(duì)照組。置管前指導(dǎo)兩組病人填寫狀態(tài)焦慮量表(S-AI),測(cè)評(píng)病人的情緒狀態(tài),并收集病人的一般資料及臨床實(shí)驗(yàn)室檢查指標(biāo)。將收集到的數(shù)據(jù)輸進(jìn)計(jì)算機(jī),使用SPSS 11.5軟件包進(jìn)行統(tǒng)計(jì)分析,導(dǎo)致穿刺點(diǎn)持續(xù)滲血的不同因素間比較采用2檢驗(yàn)和t檢驗(yàn),持續(xù)滲血多因素分析采用Logistic回回分析。第二部分:收集同期住院治療初次使用PICC導(dǎo)管的急性白血病病人。進(jìn)組病人置進(jìn)PICC后觀察3個(gè)月,根據(jù)靜脈炎的診斷標(biāo)準(zhǔn),出現(xiàn)靜脈炎的病人進(jìn)靜脈炎組,未出現(xiàn)靜脈炎的病人進(jìn)對(duì)照組。指導(dǎo)患者填寫特質(zhì)焦慮量表(T-AI),測(cè)評(píng)病人的情緒狀態(tài),并收集患者的一般資料和實(shí)驗(yàn)室

3、檢查指標(biāo)。將收集到的數(shù)據(jù)輸進(jìn)計(jì)算機(jī),使用SPSS 11.5軟件包進(jìn)行統(tǒng)計(jì)分析,導(dǎo)致靜脈炎的不同因素間的比較采用2檢驗(yàn)和t檢驗(yàn),靜脈炎多因素分析采用Logistic回回分析。結(jié)果第一部分:單因素分析結(jié)果表明:血小板計(jì)數(shù)(t=3.807,P=0.000;2=6.372,P=0.041),置管前患者單純輸注紅細(xì)胞(2=5.735,P=0.017)、置管時(shí)患者情緒狀態(tài)(2=4.538,P=0.033)與患者持續(xù)滲血存在相關(guān)關(guān)系;患者性別(2=2.256,P=0.133)、患者年齡(t=1.624,P=0.110;2=2.627,P=0.105)、血漿凝血酶原時(shí)間(t=-1.109,P=0.272;2=

4、1.154,P=0.283)、活化部分的凝血活酶時(shí)間(t=-0.671,P=0.505;2=1.154,P=0.283)、凝血酶時(shí)間(t=-0.179,P=0.858;2=0.323,P=0.570)、血清鈣水平(t=0.829,P=0.414)則與持續(xù)滲血的發(fā)生無關(guān)。多因素條件Logistic回回分析結(jié)果顯示:血小板計(jì)數(shù)(OR=0.269,P=0.014)、置管前單純輸注紅細(xì)胞(OR=5.236,P=0.014)、置管前患者情緒狀態(tài)(OR=6.497,P=0.027)與穿刺點(diǎn)持續(xù)滲血的發(fā)生有關(guān)。第二部分:單因素分析結(jié)果表明穿刺靜脈(2=10.252,P=0.006)、穿刺次數(shù)(2=10.42

5、4,P=0.001)、活動(dòng)度(2=6.810,P=0.009)、穿刺后屈肘(2=6.178,P=0.013)、血糖水平(t=-2.499,P=0.015)、情緒狀態(tài)(2=6.023,P=0.014)與靜脈炎的發(fā)生存在相關(guān)關(guān)系;患者性別(2=0.104,P=0.747)、患者年齡(2=1.913,P=0.384)、白血病類型(2=0.002,P=0.962)、過敏體質(zhì)(2=0.316,P=0.574)、患者免疫功能(2=3.113,P=0.078)、白細(xì)胞計(jì)數(shù)(t=1.421,P=0.159)、中性粒細(xì)胞計(jì)數(shù)(t=-1.111,P=0.270)則與靜脈炎的發(fā)生無關(guān)。多因素條件Logistic回回

6、分析結(jié)果顯示:貴要靜脈(OR=2.985,95%CI:1.2547.105)是靜脈炎發(fā)生的保護(hù)因素;反復(fù)多次插管(OR=5.083,95%CI:1.18421.815)、穿刺后過度活動(dòng)(OR=6.415,95%CI:1,08537.932)、持續(xù)存在的焦慮情緒(OR=8.211,95%CI:1.92035.125)是發(fā)生靜脈炎的危險(xiǎn)因素。結(jié)論第一部分:本研究結(jié)果顯示,急性白血病病人血小板計(jì)數(shù)低、單純輸注紅細(xì)胞治療、緊張焦慮情緒狀態(tài)三個(gè)因素是急性白血病病人PICC穿刺點(diǎn)持續(xù)滲血的危險(xiǎn)因素。因此,置管前充分評(píng)估病人血小板計(jì)數(shù),是否單純輸注紅細(xì)胞以及病人的情緒狀態(tài)是一重要環(huán)節(jié)。醫(yī)護(hù)職員可以針對(duì)不同個(gè)

7、體采取相應(yīng)的護(hù)理措施,減少患者植進(jìn)PICC后滲血的發(fā)生。第二部分:本研究結(jié)果顯示,急性白血病病人穿刺靜脈的不同、置管過程中反復(fù)多次穿刺,置管后經(jīng)常屈肘、穿刺側(cè)肢體過度活動(dòng)、高血糖水平和持續(xù)存在的焦慮情緒六個(gè)因素與靜脈炎的發(fā)生存在相關(guān)關(guān)系。因此,提示對(duì)急性白血病患者的護(hù)理應(yīng)高度重視這些因素,密切關(guān)注患者的身心題目,以采取相應(yīng)的護(hù)理措施,做好PICC導(dǎo)管的維護(hù),減少靜脈炎的發(fā)生。');【Abstract】 ObjectiveTo investigate the risk factors in durative staxis and phlebitis of acute leukaemia

8、patients with PICC and use effective preventive nursing measures.MethodThe first portion:Patients first diagnosed as acute leukaemia and first using Peripherally Inserted Central Catheters(PICC) recruited from November,2007 to October,2008 in the leukaemia department,Blood Disease Research Institute

9、, Chinese Academy of Medical Science.All patients were observed for 72h.According to the diagnostic criterion of durative staxis,patients were divided into durative staxis group and control group.Anxious emotion was assessed by questionnaire S-AI. Information on patients and data(including plt,PT,AP

10、TT,TT,serus ca level) were colleted.All data were analyzed by SPSS 11.5.The different factors which lead to durative staxis were analyzed by Chi-square test and t-test.Logistic regression model were used for multivariate analysis.The second portion:Patients diagnosed as acute leukaemia who first use

11、d Peripherally Inserted Central Catheters(PICC) recruited at the same time.Patients were observed for 3 months.According to the diagnostic criterion of phlebitis, patients were divided into phlebitis group and control group.Durative anxious emotion was assessed by questionnaire T-AI.Information on p

12、atients and data (including WBC,N,IgG,)were colleted All data were analyzed by the statistic software of SPSS 11.5.The different factors which lead to phlebitis were analyzed by Chi-square test and t-test.Logistic regression model were used for multivariate analysis.Result:The first portion:The resu

13、lts of univariate analysis showed that platelet counts (t=3.807,P=0.000),* erythrocyte transfusion before insertion of PICC (x2=5.735,P=0.017) and patients emotion(x2=4.538,P=0.033) were associated with durative staxis.Meanwhile,gender(x2=2.256,P=0.133),age(x2=2.627,P=0.105), prothrombin time(x2=1.1

14、54,P=0.283),activated partial thromboplastin time(x2= 1.154,P=0.283),TT(x2=0.323,P=0.570),serus ca level(t=0.829,P=0.414) were not associated with durative staxis.The results of multivariate logistic regression analysis showed that platelet counts(OR=0.269,95%CI:0.0950.766) was the protective factor

15、 of durative staxis.Simple erythrocyte transfusion before inserting PICC(OR=5.236,95%CI:1.40719.490) and anxious emotion(OR=6.497,95%CI: 1.23734.129) were the risk factors.The second part:The results of univariate analysis showed that location of inserted vein(x2=10.252,P=0.006),inserting vein numbe

16、r(x2=10.424,P=0.001), activity of inserted limb(x2=6.810,P=0.009),elbow bending(x2=6.178,P=0.013), blood sugar level(t=-2.499,P=0.015) and emotion(x2=6.023,P=0.014) were associated with phlebitis.Meanwhile,gender(x2=0.104,P=0.747),age(x2=1.913, P=0.384),type of acute leukaemia(x2=0.002,P=0.962),alle

17、rgic habitus(x2=0.316, P=0.574),immune function(x2=3.113,P=0.078),WBC(t=1.421,P=0.159),N (t=-1.111,P=0.270) were not associated with phlebitis.The results of multivariate logistic regression analysis showed that basilica vein was the protective factor. Multiple insertings,more activity of inserted l

18、imb,durative anxious emotion were the risk factors.ConclusionThe first part:Low platelet counts,* erythrocyte transfusion and anxious emotion are the risk factors of durative staxis.Therefore patients can reduce the occurring of durative staxis by well estimating platelet,only erythrocyte transfusion or not before insertion of PICC and patient' emotion state and by take nursi