李祖媚; 李民; 蔡美霞; 孙洁群; 梁素芳; 陈嘉荣; 陈桃

doi:10.3760/cma.j.cn221370-20200505-00945

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• 临床护理 •

血栓弹力图联合D-二聚体检测对PICC血栓风险早期预警的意义

国际护理学杂志, 2021,40(18) : 3336-3339. DOI: 10.3760/cma.j.cn221370-20200505-00945

摘要

目的

探讨血栓弹力图(TEG)联合D-二聚体(D-D)检测在经外周静脉置入中心静脉导管(PICC)血栓风险早期预警的意义。

方法

选择2019年3月至2021年2月江门市中心医院PICC置管患者180例，所有患者均予置管后1 w、2 w时间点完成血管彩超血栓筛查，根据筛查结果分为血栓组、无血栓组。两组均在PICC置管前T0(0~1 d)、置管后T1(4~7 d)两个时间点检测TEG和D-D；绘制ROC曲线，分析血栓弹力图联合D-D在PICC血栓风险早期中的预警效能(诊断敏感性、特异性)。

结果

血栓组血栓弹力图中凝血反应时间(R)、血细胞凝块形成时间(K)低于无血栓组，差异有统计学意义(P<0.05)；血栓组血栓弹力图中K、CI、最大振幅(MA)、血细胞凝块形成速率(ε)及D-D水平均高于无血栓组，差异有统计学意义(P<0.05)；ROC曲线结果表明：血栓弹力图联合D-D在PICC血栓风险早期中预警敏感性、特异性均高于单一血栓弹力图和D-D，差异有统计学意义(P<0.05)。

结论

血栓弹力图联合D-D检测用于PICC血栓风险中效果理想，能实现早期预警，获得较高的预测敏感性、特异性，值得推广应用。

引用本文: 李祖媚, 李民, 蔡美霞, 等. 血栓弹力图联合D-二聚体检测对PICC血栓风险早期预警的意义 [J] . 国际护理学杂志, 2021, 40(18) : 3336-3339. DOI: 10.3760/cma.j.cn221370-20200505-00945.

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经外周静脉置入中心静脉导管(PICC)是从外周静脉穿刺置管，其导管尖端位于上腔静脉或锁骨下静脉的一种深静脉置管方法^〔1〕。目前，PICC已经广泛用于静脉营养治疗、化疗药物干预、急危重症患者抢救的首选静脉通道。既往研究表明：PICC的使用能避免化疗药物与手臂静脉的直接接触，加大静脉血流速度，能迅速稀释化疗药物，避免药物对血管的持续刺激^〔2〕。但是，PICC临床使用时亦存在一定局限性，患者治疗后深静脉血栓发生率较高，且严重者将会发展为肺栓塞，增加临床死亡率^〔3〕。数据调查结果表明^〔4〕：与PICC有关的静脉血栓发生率为1%~4%，影响患者治疗效果及依从性。D-二聚体(D-D)是最简单的纤维蛋白降解产物，其表达水平升高说明存在高凝状态及继发性纤维蛋白溶解亢进，能对血栓性疾病进行诊断、疗效评估及预后判断。血栓弹力图是反映血液凝固动态变化的指标，主要指标包括：凝血反应时间(R)、血细胞凝块形成时间(K)、最大振幅(MA)、血细胞凝块形成速率(ε)及凝血综合指数(CI)等，能实现血栓性疾病、血小板异常性疾病及纤溶亢进性疾病的诊断、预测^〔5〕。因此，本研究以PICC置管患者为对象，探讨血栓弹力图联合D-D检测在PICC血栓风险早期预警的意义。

贡献者信息

李祖媚

江门市中心医院　529030

李民

江门市中心医院　529030

蔡美霞

江门市中心医院　529030

孙洁群

江门市中心医院　529030

梁素芳

江门市中心医院　529030

陈嘉荣

江门市中心医院　529030

陈桃

江门市中心医院　529030

关键词

血栓弹力图; D-二聚体; PICC; 血栓风险; 早期预警;

基金项目

江门市科学技术局2019年医疗卫生领域科技计划项目（2019A025）

利益冲突

所有作者均声明不存在利益冲突

历史

出版日期：2021-09-23

本文编辑

王溪婷

Clinical Nursing

The significance of thromboelastogram combined with D-dimer as early warning index for PICC thrombosis risk

Li Zumei, Li Min, Cai Meixia, Sun Jiequn, Liang Sufang, Chen Jiarong, Chen Tao

Published 2021-09-23

Cite as Int J Nurs, 2021, 40(18): 3336-3339. DOI: 10.3760/cma.j.cn221370-20200505-00945

Abstract

Objective

To explore the significance of early detection of thromboelastogram(TEG)combined with D-dimer(D-D)as risk index of thrombosis in Peripherally Inserted Central Catheter(PICC).

Methods

A total of 180 patients with PICC catheterization in this hospital from March 2019 to February 2021 were selected.All patients were screened for vascular color doppler thrombosis at 1 week, 2 weeks after catheterization, and were divided into thrombus group and non-thrombus group according to the screening results.The TEG and D-dimer levels were detected at two time points T0(0~1 d)before and T1(4~7 d) after PICC placement in both groups.ROC curves were drawn, and thromboelastograms were analyzed together with D-D for early warning efficacy in terms of diagnostic sensitivity and specificity as early thrombotic risk in PICC.

Results

The R and K of thrombus elasticity diagram in the thrombus group were lower than those in the non-thrombus group, and the difference was statistically significant (P<0.05). The levels of K, CI, MA, ε, and D-D of the thrombosis group were higher than those of the non-thrombus group, and the difference was statistically significant(P<0.05). The results of the ROC curve showed that the sensitivity and specificity of combination of thromboelastogram and D-D were higher than of the separated data, and the difference was statistically significant (P<0.05).

Conclusions

Thromboelastogram combined with D-D test is ideal to predict the risk of PICC thrombosis, with higher predictive sensitivity and specificity to show an early warning, and is worthy of popularization and application.

Key words:

Thromboelastogram; D-dimer; Peripherally inserted central catheter; Thrombosis risk; Early warning efficacy

Contributor Information

Li Zumei