【摘要】 目的 探讨个性干预措施对耐高压经外周静脉穿刺中心静脉置管（PICC）恶性肿瘤或危重症患者的治疗效果。方法 收集2020年1月至2022年1月济宁医学院附属医院收治的258例恶性肿或危重症患者的临床资料，根据干预方法的不同将其分为常规组（n=129，于2020年1—12月采用常规干预措施）和个性组（n=129，于2021年1月至2022年1月采用个性干预措施）。比较两组患者静脉血栓栓塞症（VTE）发生率，观察干预前后两组患者置管侧上肢静脉血流速度、凝血功能指标[测凝血酶时间（TT）、凝血酶原时间（PT）、纤维蛋白原（FIB）、活化部分凝血活酶时间（APTT）、D-二聚体（D-D）水平]及心理状态[焦虑自评量表（SAS）、抑郁自评量表（SDS）评分]。结果 个性组患者VTE发生率为1.55%，低于常规组患者的8.53%，差异有统计学意义（P<0.05）。干预后，两组患者TT、PT、APTT均明显短于本组干预前，FIB、D-D水平均明显高于本组干预前，但个性组患者TT、PT、APTT均长于常规组患者，FIB、D-D水平均低于常规组患者，差异均有统计学意义（P<0.05）。干预后，两组患者穿刺静脉血流速度、SAS评分、SDS评分均低于本组干预前，但个性组患者穿刺静脉血流速度明显高于常规组患者，SAS、SDS评分均明显低于常规组患者，差异均有统计学意义（P<0.01）。结论 个性干预措施可通过促进患者穿刺静脉血流速度，改善患者穿刺置管后的凝血功能，降低耐高压PICC恶性肿瘤或危重症患者VTE的发生风险，并可有效缓解患者的不良情绪。更多还原

【Abstract】 Objective To investigate the effect of individualized intervention on malignant tumors or critically ill patients with high pressure resistant peripherally inserted central catheter(PICC). Method The clinical data of 258 patients with malignant tumors or critical illness admitted to the Affiliated Hospital of Ji’ning Medical College from January 2020 to January 2022 were collected. According to different intervention methods, they were divided into routine group(n=129, using routine intervention measures from January to December 2020) and individualized group(n=129, using individual intervention measures from January 2021 to January 2022). The occurrence of venous thromboembolism(VTE) in the two groups was compared. Before and after the intervention, the venous blood flow velocity and coagulation function indexes [thrombin time(TT), prothrombin time(PT), fibrinogen(FIB), activated partial thromboplastin time(APTT), D-dimer(D-D) level] and mental state [self-rating anxiety scale(SAS), selfrating depression scale(SDS) scores] were compared between the two groups. Result The incidence of VTE in the individualized group was 1.55%, lower than 8.53% in the conventional group, the difference was statistically significant(P<0.05). After the intervention, the TT, PT, and APTT of the two groups were significantly shorter than themselves before the intervention, and the levels of FIB and D-D were significantly higher than themselves before the intervention,however, the TT, PT, and APTT in the group were longer than those in the routine group, the levels of FIB and D-D were lower than those in the routine group, the differences were statistically significant(P<0.05). After the intervention, the puncture venous blood flow velocity, the SAS and SDS scores of the patients in the two groups were lower than those in the same group before the intervention, however, the blood flow velocity of puncture veins in the personality group was significantly higher than that in the routine group, the SAS and SDS scores were significantly lower than those in the individualized group, the differences were statistically significant(P<0.01). Conclusion Personalized interventions could improve the coagulation function of patients after puncture catheterization by promoting the blood flow velocity of punctured veins, reduce the risk of VTE in patients with high pressure resistant PICC malignant tumor and critically ill,or could effectively relieve patients’ negative emotions.更多还原