PICC留置患者の血栓症関連因子の解析

Analysis of factors related to thrombosis in patients with PICC placements.

抄録

本研究の目的は、末梢挿入型中心静脈カテーテル（PICC）留置患者の状態を調査し、PICC留置患者の血栓症に影響する危険因子を分析し、より正確で効果的なPICC管理戦略を策定することである。PICC留置を受けた合計147人の患者を研究対象として選択した。臨床データを収集し、患者を血栓症群と非血栓症群に分けた。ビリルビン、白血球、静脈圧、ヘパリン濃度、血流量、クエン酸、血小板の値を検出した。独立した危険因子を分析するために、Pearsonカイ二乗検定、Spearman相関分析、単変量および多変量ロジスティック回帰を採用した。147例のPICC留置患者のうち、男性84例、女性63例であった。血栓症は116例に発生し、発生率は78.91％であった。Pearson chi-square検定により、クエン酸、血流、血小板、虚弱（P<.001）と血栓形成との間に有意な相関が示された。スピアマン相関分析により、PICC留置患者におけるクエン酸（ρ=-0.636、P<.001）、血流（ρ=0.584、P<.001）、血小板数（ρ=0.440、P<.001）、虚弱（ρ=-0.809、P<.001）と血栓症の間に有意な相関があることが示された。単変量ロジスティック回帰分析では、血栓症形成とクエン酸（OR=0.022、95％CI=0.006-0.08、P<.001）、血流（OR=33.973、95％CI=9.538-121.005、P<.001）、血小板数（OR=22.065、95％CI=5.021-96.970、P<.001）、虚弱（OR=0.003、95％CI=0.001-0.025、P<.001）であった。多変量ロジスティック回帰分析でも、血栓形成とクエン酸（OR=0.013、95％CI=0.002-0.086、P<.001）、血流（OR=35.064、95％CI=6.385-192.561、P<.001）、血小板数（OR=4.667、95％CI=0.902-24.143、P<.001）、虚弱（OR=0.006、95％CI=0.001-0.051、P<.001）であった。しかし、性別（OR=0.544、95％CI=0.113-2.612、P=.447）、年齢（OR=4.178、95％CI=0.859-20.317、P=.076）、ビリルビン（OR=2.594、95％CI=0.586-11.482、P=.209）、白血球（OR=0.573、95％CI=0.108-3.029、P=.512）、静脈圧（OR=0.559、95％CI=0.129-2.429、P=.438）、ヘパリン濃度（OR=2.660、95％CI=0.333-21.264、P=.356）は血栓形成との有意な相関を示さなかった。PICC留置患者は血栓症のリスクが高く、クエン酸、血流、血小板数、虚弱が主な危険因子である。

This study aimed to investigate the conditions of patients with peripherally inserted central catheter (PICC) placements, analyze the risk factors influencing thrombosis in PICC-placed patients, and formulate more accurate and effective PICC management strategies. A total of 147 patients undergoing PICC placements were selected as the study subjects. Clinical data were collected, and the patients were divided into thrombosis and non-thrombosis groups. Detect levels of bilirubin, white blood cells, venous pressure, heparin concentration, blood flow, citric acid, and platelets. Pearson chi-square test, Spearman correlation analysis, as well as univariate and multivariate logistic regression were employed to analyze independent risk factors. Among the 147 patients with PICC placements, there were 84 males and 63 females. Thrombosis occurred in 116 cases, with an incidence rate of 78.91%. Pearson chi-square test showed a significant correlation between citric acid, blood flow, platelets and frailty (P < .001) with thrombosis formation. Spearman correlation analysis revealed a significant correlation between citric acid (ρ = -0.636, P < .001), blood flow (ρ = 0.584, P < .001), platelet count (ρ = 0.440, P < .001), frailty (ρ = -0.809, P < .001) and thrombosis in PICC placement patients. Univariate logistic regression analysis indicated a significant correlation between thrombosis formation and citric acid (OR = 0.022, 95% CI = 0.006-0.08, P < .001), blood flow (OR = 33.973, 95% CI = 9.538-121.005, P < .001), platelet count (OR = 22.065, 95% CI = 5.021-96.970, P < .001), frailty (OR = 0.003, 95% CI = 0.001-0.025, P < .001). Multivariate logistic regression analysis also showed a significant correlation between thrombosis formation and citric acid (OR = 0.013, 95% CI = 0.002-0.086, P < .001), blood flow (OR = 35.064, 95% CI = 6.385-192.561, P < .001), platelet count (OR = 4.667, 95% CI = 0.902-24.143, P < .001), frailty (OR = 0.006, 95% CI = 0.001-0.051, P < .001). However, gender (OR = 0.544, 95% CI = 0.113-2.612, P = .447), age (OR = 4.178, 95% CI = 0.859-20.317, P = .076), bilirubin (OR = 2.594, 95% CI = 0.586-11.482, P = .209), white blood cells (OR = 0.573, 95% CI = 0.108-3.029, P = .512), venous pressure (OR = 0.559, 95% CI = 0.129-2.429, P = .438), and heparin concentration (OR = 2.660, 95% CI = 0.333-21.264, P = .356) showed no significant correlation with thrombosis formation. Patients with PICC placements have a higher risk of thrombosis, citric acid, blood flow, platelet count and frailty are the main risk factors.