摘要
目的探讨在不同凝血状态的恶性肿瘤患者中不同外周静脉置入中心静脉导管(PICC)冲管液肝素浓度对穿刺点延时渗血发生率的影响。方法共340例患者,其中242例在PICC置管术前根据血小板计数和凝血酶原时间、凝血酶时间测定、活化部分凝血活酶时间、纤维蛋白原凝血4项检测结果分为低凝血(A组)、正常凝血(B组)和高凝血(C组)3组,每组分别随机采用3种不同肝素浓度导管封管液(A组为生理盐水1、2.5 U/mL、25 U/mL,B组为12.5 U/mL、25 U/mL、50 U/mL,C组为25 U/mL、50 U/mL、75 U/mL)。98例为不分凝血状态采用同一肝素浓度封管液(50 U/mL)的对照组(D组)。结果所有患者总渗血发生率为30.9%(105/340)。A组、B组、C组渗血发生率分别为25.4%(16/63)、25.8%(23/89)、23.3%(21/90)(P>0.05),D组渗血发生率45.9%(45/98)显著高于A、B、C 3组(P<0.01)。在A、B、C组中,采用不同肝素浓度封管液患者的渗血发生率差异均无统计学意义(P>0.05)。在D组中,低凝血状态患者的渗血发生率88.2%(15/17)显著高于正常凝血的38.9%(28/72)和高凝血状态的22.2%(2/9)(P<0.01)。结论本研究结果提示,根据PICC置管术前检测患者的血小板计数及凝血状态选择合适的封管液肝素浓度,对降低穿刺点延迟性渗血发生率具有一定的临床价值。
Objective To investigate the influence of heparin concentration of pipe-washing fluid on the incidence rate of delayed bleeding of peripherally inserted central catheter（PICC）puncture points in cancer patients with different coagulation status.Methods Among 340 cancer patients,242 were divided into low coagulation group（Group A）,normal coagulation group（Group B） and high coagulation group（Group C） according to the test results of platelet count,prothrombin time,thrombinogen time,activated partial thromboplastin time and fibrinogen coagulation before PICC placement.Each group randomly received three pipe-washing fluids of different heparin concentration（physiological saline,12.5 U/mL and 25 U/mL for group A;12.5 U/mL,25 U/mL and 50 U/mL for group B;25 U/mL,50 U/mL and 75 U/mL for group C）.Another 98 patients with the same heparin concentration of pipe-washing fluid（50 U/mL） was named group D.Results The total incidence rate of bleeding was 30.9%（105/340）.The incidence rate of delayed bleeding in Group A,B and C was 25.4%（16/63）,25.8%（23/89） and 23.3%（21/90）,respectively（P〉0.05）.The incidence rate of delayed bleeding in group D was 45.9%（45/98）,which was significantly higher than groups A,B and C（P〈0.01）.There was no statistical significance in the incidence rate of delayed bleeding with different heparin concentration of pipe-washing fluid among groups A,B and C（P〉0.05）.The incidence rate of delayed bleeding in the patients withlowcoagulation status（88.2 %,15/17） was significantly higher than patients with normal（38.9 %,28/72） and high coagulation status（22.2 %,2/9）（P〈0.01）.Conclusion The re-sults suggest that detection of patients with platelet count and coagulation status before PICC placement isi mportant for selection of appropriate heparinconcentration of pipe-washing fluid as well as the decrease of incidence rate of delayed bleeding.
出处
《实用临床医药杂志》
CAS
2012年第16期1-4,共4页
Journal of Clinical Medicine in Practice
基金
江苏省肿瘤医院科学基金资助项目(ZH200801)
关键词
外周静脉置入中心静脉导管
凝血状态
肝素浓度
封管液
穿刺点延时性渗血
peripherally inserted central catheter
coagulation status
heparin concen-tration
pipe- washing
puncture point delayed bleeding
