老年血液病患者PICC穿刺点渗血危险因素的回顾性分析

doi:10.3969/j.issn.1003-9198.2026.09.018

摘要/Abstract

摘要： 目的分析老年血液病患者经外周静脉置入中心静脉导管(PICC) 穿刺点渗血相关危险因素。方法回顾性收集238例PICC患者的临床资料,收集凝血、营养、炎症、血管代谢、穿刺操作等多维度指标;采用单因素及多因素logistic回归分析穿刺点渗血的影响因素;通过Hosmer-Lemeshow检验、ROC 曲线验证模型的拟合及预测效能。结果单因素分析显示,年龄、合并糖尿病、收缩压、舒张压、空腹血糖、糖化血红蛋白、总胆固醇、甘油三酯、LDL-C、PLT、凝血酶原时间(PT)、白蛋白(Alb)、CRP、中性粒细胞/淋巴细胞比值(NLR)、置管穿刺情况以及扩皮方式均与渗血相关(P均＜0.05)。多因素logistic回归结果显示,年龄≥80 岁、PLT≤25×10⁹/L、Alb≤35 g/L、CRP≥10 mg/L、置管反复穿刺、收缩压≥138 mmHg、糖化血红蛋白≥6.0%、LDL-C≥3.0 mmol/L 为渗血的独立危险因素。ROC曲线分析结果显示,模型预测渗血的 AUC为0.861;H-L拟合优度检验结果显示,χ²=7.136,P=0.522,表明拟合优度与预测效果均良好。结论置管前全面评估患者年龄、PLT、营养、炎症及血管代谢等相关高危因素,规范穿刺操作、提高一次性穿刺成功率,实施个体化穿刺点压迫护理,可减少渗血发生。

关键词: 老年人, 血液病, 经外周静脉置入中心静脉导管, 穿刺点渗血, 危险因素

Abstract: Objective To analyze the risk factors associated with blood oozing at peripherally inserted central catheter (PICC) puncture sites in elderly patients with hematological diseases. Methods We retrospectively investigated clinical data from 238 PICC patients, with multi-dimensional indicators including coagulation, nutrition, inflammation, vascular metabolism, and puncture procedure collected. Univariate and multivariate logistic regression analyses were used to identify the influencing factors of puncture site oozing. The Hosmer-Lemeshow test and receiver operating characteristic (ROC) curve were applied to verify the model’s goodness of fit and predictive performance. Results Univariate analysis showed that age, diabetes mellitus, systolic blood pressure, diastolic blood pressure, fasting blood glucose, glycosylated hemoglobin, total cholesterol, triglyceride, low-density lipoprotein cholesterol (LDL-C), platelet count (PLT), prothrombin time (PT), albumin (Alb), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), puncture conditions, skin dilation method were associated with blood oozing (all P<0.05). Multivariate logistic regression analysis confirmed that age ≥ 80 years, PLT≤25×10⁹/L, Alb≤35 g/L, CRP≥10 mg/L, repeated catheterization punctures, systolic blood pressure≥138 mmHg, glycated hemoglobin≥6.0%, and LDL-C≥3.0 mmol/L were independent risk factors for blood oozing. ROC curve analysis showed that the area under the curve (AUC) of the model for predicting puncture site oozing was 0.861; The Hosmer-Lemeshow goodness-of-fit test yielded aχ² value of 7.136, with P=0.522, indicating excellent goodness of fit and satisfactory predictive performance of the model. Conclusions Comprehensive assessment of high-risk factors related to advanced age, PLT, nutrition, inflammation, and vascular metabolism before catheterization, standardized puncture procedures, improvement of the success rate of one-time puncture, and implementation of individualized puncture site compression nursing can reduce the occurrence of blood oozing.

Key words: aged, hematological disease, peripherally inserted central catheters, puncture site oozing, risk factor

中图分类号:

R 473.5

陆蓉, 梁玉萍, 杨雪梅, 华思思, 严瑾, 王洁, 王玮. 老年血液病患者PICC穿刺点渗血危险因素的回顾性分析[J]. 实用老年医学, 2026, 40(9): 957-961.

LU Rong, LIANG Yuping, YANG Xuemei, HUA Sisi, YAN Jin, WANG Jie, WANG Wei. Retrospective analysis of risk factors for PICC puncture site oozing in elderly patients with hematological diseases[J]. Practical Geriatrics, 2026, 40(9): 957-961.

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