癌症患者中心静脉导管置管后置管相关性血栓的独立危险因素分析

Analysis of Independent Risk Factors for Catheter-Related Thrombosis in Cancer Patients after Central Venous Catheter Placement

摘要: 背景：癌症患者由于肿瘤微环境变化处于高凝状态，导致静脉血栓发生率增高。随着中心静脉导管(CVC)置管的广泛应用，置管相关性血栓形成(CRT)发生率也随之升高，但CVC置管相关性血栓形成(CRT)的危险因素仍不清楚。目的：本研究拟通过对癌症患者中心静脉导管(CVC)置管后血栓形成(CRT)的发生率及危险因素的分析，为临床识别高风险患者、实施早期干预、提升患者生存质量提供依据。方法：回顾性分析2020年1月1日至2025年1月1日期间254名癌症患者的临床资料，分为血栓组和非血栓组，采用卡方检验或t检验分析各因素与CRT的关系，并通过二元logistic回归进行多因素变量分析。结果：在中位导管留置时间为4天的情况下，92例(36.2%)患者发生CRT，血栓主要位于右侧颈内静脉下段及中下段。单因素分析显示，VTE评分、纤维蛋白原水平、甘油三酯、总胆固醇、低密度脂蛋白及导管留置时间与CRT相关(P < 0.05)。多因素分析确认，纤维蛋白原水平(OR = 5.75, 95% CI: 2.82~11.73, P < 0.001)、甘油三酯(OR = 4.49, 95% CI: 1.89~10.71, P < 0.001)及导管留置时间(OR = 4.7, 95% CI: 2.37~9.32, P < 0.001)为CRT的独立危险因素(导管留置时间以天为单位)。结论：纤维蛋白原升高、高甘油三酯及较长的导管留置时间与CRT形成正相关。这些发现为临床风险评估和管理提供了重要依据，提示在治疗过程中需特别关注这些因素，以改善恶性肿瘤患者的预后。

Abstract: Background: Cancer patients are in a hypercoagulable state due to changes in the tumor microenvironment, resulting in an increased incidence of venous thrombosis. With the widespread use of central venous catheters (CVCs), the incidence of catheter-related thrombosis (CRT) has also increased, but the risk factors for CVC-related thrombosis remain unclear. Objective: This study aims to analyze the incidence and risk factors of catheter-related thrombosis (CRT) in cancer patients following CVC placement, to provide a basis for clinical identification of high-risk patients, early intervention, and improvement of patient quality of life. Methods: A retrospective analysis was conducted on the clinical data of 254 cancer patients from January 1, 2020, to January 1, 2025. Patients were divided into thrombosis and non-thrombosis groups. Chi-square test or t-test was used to analyze the relationship between various factors and CRT, and multivariate analysis was performed using binary logistic regression. Results: Among patients with a median catheter indwelling time of 4 days, 92 patients (36.2%) developed CRT, with thrombosis primarily located in the lower and middle-lower segments of the right internal jugular vein. Univariate analysis showed that VTE score, fibrinogen level, triglycerides, total cholesterol, low-density lipoprotein, and catheter indwelling time were associated with CRT (P < 0.05). Multivariate analysis confirmed that fibrinogen level (OR = 5.75, 95% CI: 2.82~11.73, P < 0.001), triglycerides (OR = 4.49, 95% CI: 1.89~10.71, P < 0.001), and catheter indwelling time (OR = 4.7, 95% CI: 2.37~9.32, P < 0.001) were independent risk factors for CRT (catheter indwelling time in days). Conclusion: Elevated fibrinogen, high triglycerides, and longer catheter indwelling time are positively correlated with CRT. These findings provide important evidence for clinical risk assessment and management, indicating that special attention should be paid to these factors during treatment to improve the prognosis of patients with malignant tumors.