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1、成人患者PICC使用及闲置情况调查分析成人患者 PICC 闲置情况的调查性研究摘要研究目的：国外越来越多的研究关注闲置静脉导管，然而闲置（Idle）这一概念目前还未引入国内。闲置静脉导管是指临床指征消失后仍留在患者体内的导管。国内尚未有研究对成人患者经外周静脉置入中心静脉导管(PeripherallylnsertedCentral Catheter, PICC)的闲置发生情况进行报道，其闲置的风险也并未评估。因此，本课题使用自制成人患者PICC使用及闲置情况调查表，抽样调查上海市五所三甲医院成人患者PICC闲置情况，并分析闲置的风险和影响因素，弥补国内在此方面研究的空白，引起医务人员对此的重视
2、，同时为今后进一步探究PICC拔除时机提供资料，促进PICC安全拔除。研究方法：本研究应用横断面的研究方法，采取方便抽样调查2018年4月1日至2018年7月31日上海市五所三级甲等医院PICC拔管的成人患者，严格按照纳入和排除标准选取研究对象。研究者通过直接询问患者以及浏览患者病例填写成人患者PICC使用及闲置情况调查表，收集患者的一般信息、疾病和治疗信息、PICC使用情况和PICC闲置情况。运用SPSS 20.0对数据进行统计和分析，采用频数、构成比、均数、标准差对患者进行描述性分析，计数资料采用卡方检验，计量资料采用t检验、方差分析或Kruskal-Wallis检验（方差不齐时），对PI
3、CC闲置的影响因素进行单因素分析和Logistic回归分析。研究结果：358名PICC拔管患者总PICC留置时间58000天。根据研究制定的标准，其中5311天（9.2%）是闲置的，255名（71.2%）研究对象PICC存在闲置。平均闲置天数15天，129名（36%）患者PICC闲置天数超过15天，53名（14.8%）患者PICC闲置天数超过30天。PICC相关并发症的总体发生率为19.8%，PICC闲置组和非闲置组患者并发症发生率差异无统计学意义（P0.05），但闲置天数15天的患者和≥15天的患者总体并发症、移位和局部感染发生率有显着性差异（P0.05）。本调查单因素及多因素Logi
4、stic回归分析结果显示，人际交往程度、自觉PICC影响程度、医疗付费方式、化疗次数、置入手臂、拔管建议为PICC闲置的独立危险因素，且PICC闲置时间和人际交往程度、自觉PICC影响和拔管建议密切相关。研究结论：目前，临床上对于PICC的拔管关注不够，PICC闲置的情况十分常见，应针对性地进行管理和改进。对于病情稳定的患者，应在治疗结束后立即拔除PICC，减轻患者的负担和风险。对于化疗患者或病情易变化的患者，PICC在闲置15内并发症发生率低，在治疗结束后可根据病情需要观察一段时间（最好2周内）拔除。关键词：经外周静脉置入中心静脉导管；闲置；导管相关并发症；拔管。Study on the i
5、dle peripherally insertedcentral catheters in adult patientsAbstractObjective:Increasingstudiesabroadconcernaboutidlevascularaccessdevices. However, the concept of idle has not been introduced to China. Intravascular cathetersretainedunnecessarilywithoutmedicalindicationwerereferredtoasidle;lines. T
6、here still scant data on idle PICCs (peripherally inserted central catheters) and the riskofidlePICCsisunknown.Therefore,weusedself-madequestionnaireto investigate the adult patients with PICCs at five academic tertiary care institutions in Shanghai and assessed the prevalence, risks and risk factor
7、s of idle PICC to make up for the blank of domestic research in this aspect, provide information for further study and promote the safe removal of PICCs.Method:BetweenApril2018andJuly2018,weperformedacross-sectional observational study at five academic tertiary care institutions in Shanghai based on
8、 aconveniencesamplingmethod.Datawereabstractedusingasitequestionnaireby directlyinquiringandmedicalrecordsreviewingregardingbasic patientdemographics,andPICCscharacteristics(insertion,maintenanceandremoval information) right after the PICCs were removed. Statistical analysis used SPSS 20.0.Quantitat
9、ivevariableswerereportedasthemeanwithstandarddeviation(SD), whereascategoricalvariableswereexpressedasfrequencydistribution percentage with95%confidenceintervals(CIs).Categoricalvariableswerecomparedusing Chi-square test, continuous variables were compared using Student s t test, AnalysisofVariance(
10、ANOVA)orKruskal-Wallistest.UnivariateanalysisandLogistic regression analysis were performed to analyze the risk factors of idle PICCs.Result:358 patients with 358 PICCsepisodeswho met the inclusion criteria were studied. Of the 58000 total catheter-days recorded, 5311 (9.2%) were considered as idle
11、based on our study criteria. 255 (71.2%) patients had at least one idle catheter-day with a mean duration of 14.84 (19.31) idle days. The idle days of PICCs in 129 (36%) patients were more than 15 days and in 53 (14.8%) patients were more than 30 days.TheoverallincidenceofPICC-relatedcomplicationswa
12、s19.8%.Therewasno statistically significant difference in the incidence of complications between the idlegroupandthenon-idlegroup(P0.05),buttheincidenceofcatheter-related complications in patients with idle PICCs days≥15d was higher than that in patientswithout idle PICCs days15d (P第五章结 论1.1本调查发现
13、上海市三甲医院成人患者PICC闲置情况很常见，71.2%的研究对象PICC治疗结束后未及时拔除而闲置，9.2%的PICC留置时间是闲置的。平均闲置天数15天，36%的患者PICC闲置天数超过15天，14.8%的患者PICC闲置天数超过30天。1.2本调查发现PICC相关并发症的总体发生率为19.8%，PICC闲置组和非闲置组患者并发症发生率差异无统计学意义（P0.05）。但闲置天数15天的患者和≥15天的患者总体并发症、移位和局部感染发生率有显着性差异（P0.05）。1.3本调查单因素及多因素Logistic回归分析结果显示，人际交往程度、自觉PICC影响程度、医疗付费方式、化疗次数、置入手臂、拔管建议为PICC闲置的独立危险因素，且PICC闲置时间和人际交往程度、自觉PICC影响和拔管建议密切相关。参考文献.