PICC与常规静脉注射治疗对乳腺癌化疗效果及依从性的影响
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摘要
目的分析经外周静脉穿刺中心静脉置管(PICC)和常规静脉注射不同给药方式对乳腺癌患者化疗效果及依从性的影响。方法回顾性分析100例乳腺癌术前化疗患者的临床资料。根据给药方式不同,分为PICC组(PICC给药)50例和iv组(常规静脉注射给药)50例。比较两组患者的疗效、不良反应发生率、并发症发生率及用药依从性。结果两组患者的有效率均为90%,且均无血栓形成。PICC组患者局部疼痛、过敏反应、穿刺点感染、导管脱落、静脉炎、注射部位穿刺点出血或血肿的发生率均明显低于iv组,差异均有统计学意义(P﹤0.01)。PICC组患者的用药依从性明显优于iv组,差异有统计学意义(P﹤0.01)。结论与常规静脉注射给药比较,乳腺癌术前化疗患者采用PICC给药方式,可明显降低局部注射的不良反应和并发症的发生率,明显改善患者化疗的用药依从性。
Objective To analyze and compare the therapeutic effects and medication compliance of preoperative chemotherapy given by peripherally inserted central venous catheter(PICC) or routine intravenous injection in breast cancer patients.Method A retrospective analysis was performed on 100 patients with preoperative chemotherapy for breast cancer.Among them,50 patients were administered with chemotherapy through PICC(PICC group),and another 50 were with conventional intravenous injection(iv group).The clinical effects,incidence of adverse reactions and complications as well as the medication compliance were compared between the two groups.Result The response rate in both groups was 90% consistently,besides,there was no occurrence of thrombosis observed.The incidence of local pain,hypersensitivity reactions,infection at puncture site,catheter falling,phlebitis,bleeding at injection site and hematoma in PICC group were all lower than those in the iv group,showing statistically significant differences(P<0.01).Furthermore,patients in PICC group had better medication compliance than those in iv group,demonstrating statistically significant differences(P<0.01).Conclusion Compared with routine intravenous administration,the use of PICC in preoperative chemotherapy for breast cancer can significantly reduce the occurrence of adverse reactions at injection site,with less complications,thus may improve patients' medication compliance.
Objective To analyze and compare the therapeutic effects and medication compliance of preoperative chemotherapy given by peripherally inserted central venous catheter(PICC) or routine intravenous injection in breast cancer patients.Method A retrospective analysis was performed on 100 patients with preoperative chemotherapy for breast cancer.Among them,50 patients were administered with chemotherapy through PICC(PICC group),and another 50 were with conventional intravenous injection(iv group).The clinical effects,incidence of adverse reactions and complications as well as the medication compliance were compared between the two groups.Result The response rate in both groups was 90% consistently,besides,there was no occurrence of thrombosis observed.The incidence of local pain,hypersensitivity reactions,infection at puncture site,catheter falling,phlebitis,bleeding at injection site and hematoma in PICC group were all lower than those in the iv group,showing statistically significant differences(P<0.01).Furthermore,patients in PICC group had better medication compliance than those in iv group,demonstrating statistically significant differences(P<0.01).Conclusion Compared with routine intravenous administration,the use of PICC in preoperative chemotherapy for breast cancer can significantly reduce the occurrence of adverse reactions at injection site,with less complications,thus may improve patients' medication compliance.
引文
[1]陈万青,郑荣寿.中国女性乳腺癌发病死亡和生存状况[J].中国肿瘤临床, 2015, 42(13):668-674.
[2]李占文.乳腺癌术后辅助化疗的基本原则和新进展[J].现代实用医学, 2005, 17(1):11-13.
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[9]李霞.预防性护理干预对紫杉烷类化疗性静脉炎的效果观察[J].中国药物与临床, 2018, 18(6):1063-1064.
[10]邢玉萍,孟娜燕.静脉留置针用于化疗外渗的原因分析及对策[J].实用临床护理学电子杂志, 2018, 3(23):193-195.
[11] Vidal V, Muller C, Jacquier A, et al. Prospective evaluation of PICC line related complications[J]. J Radiol, 2008,89(4):495-498.
[12] Cheong K, Perry D, Karapetis C, et al. High rate of complications associated with peripherally inserted central venous catheters in patients with solid tumours[J]. Intern Med J, 2004, 34(5):234-238.
[13] Johansson E, Hammarskj?ld F, Lundberg D, et al. Advantages and disadvantages of peripherally inserted central venous catheters(PICC)compared to other central venous lines:a systematic review of the literature[J]. Acta Oncol,2013, 52(5):886-892.
[14] Perrin G. PICC placement in the neonate[J]. N Engl J Med, 2014, 370(22):2153-2154.
[15] Bai N, Sun C, Wang J, et al. Ertapenem versus ceftriaxone for the treatment of complicated infections:a meta-analysis of randomized controlled trials[J]. Chin Med J(Engl),2014, 127(6):1118-1125.
[16] Patel GS, Jain K, Kumar R, et al. Comparison of peripherally inserted central venous catheters(PICC)versus subcutaneously implanted port-chamber catheters by complication and cost for patients receiving chemotherapy for nonhaematological malignancies[J]. Support Care Cancer,2014, 22(1):121-128.
[17]岳芹,任珂.静脉输液港与PICC在乳腺癌化疗中的应用效果研究[J].临床医学研究与实践, 2017, 2(9):13-14.
[18] Kakkos A, Bresson L, Hudry D, et al. Complication-related removal of totally implantable venous access port systems:does the interval between placement and first use and the neutropenia-inducing potential of chemotherapy regimens influence their incidence? A four-year prospective study of 4045 patients[J]. Eur J Surg Oncol, 2017, 43(4):689-695.
[19]冷金华,廖志云,钟晓红. PICC置管异位的相关因素及纠正方法[J].河南医学研究, 2015, 24(2):150-151.
[20] Cape AV, Mogensen KM, Robinson MK, et al. Peripherally inserted central catheter(PICC)complications during pregnancy[J]. J Parenter Enteral Nutr, 2014, 38(5):595-601.
[21] Harter C, Ostendorf T, Bach A, et al. Peripherally inserted central venous catheters for autologous blood progenitor cell transplantation in patients with haematological malignancies[J]. Support Care Cancer, 2003, 11(12):790-794.
[22]蔡幼萍,戴晓霞.乳腺癌术后经PICC化疗引起血流感染2例[J].浙江实用医学, 2018, 23(1):66-67.
[2]李占文.乳腺癌术后辅助化疗的基本原则和新进展[J].现代实用医学, 2005, 17(1):11-13.
[3]武素宁,谢兰兰. PICC与CVC在乳癌患者中的应用效果评价[J].科技风, 2016, 28(13):17-18.
[4]魏道琳. PICC并发症的预防与护理进展[J].现代护理,2005, 11(19):1607-1608.
[5] Ogston KN, Miller ID, Payne S, et al. A new histological grading system to assess response of breast cancers to primary chemotherapy:prognostic significance and survival[J]. Breast, 2003, 12(5):320-327.
[6]曾剑,梁福美.乳腺癌患者TA方案不适反应提前预防的效果观察[J].中国现代医生, 2012, 50(9):108-109.
[7] Mermel LA, Farr BM, Sherertz RJ, et al. Guidelines for the management of intravascular catheter-related infections[J].Clin Infect Dis, 2001, 32(9):1249-1272.
[8]周湖娜,宁俏.持续质控管理措施对经外周静脉穿刺中心静脉置管化疗患者预后状况分析[J].中国药物与临床,2018, 18(6):1059-1061.
[9]李霞.预防性护理干预对紫杉烷类化疗性静脉炎的效果观察[J].中国药物与临床, 2018, 18(6):1063-1064.
[10]邢玉萍,孟娜燕.静脉留置针用于化疗外渗的原因分析及对策[J].实用临床护理学电子杂志, 2018, 3(23):193-195.
[11] Vidal V, Muller C, Jacquier A, et al. Prospective evaluation of PICC line related complications[J]. J Radiol, 2008,89(4):495-498.
[12] Cheong K, Perry D, Karapetis C, et al. High rate of complications associated with peripherally inserted central venous catheters in patients with solid tumours[J]. Intern Med J, 2004, 34(5):234-238.
[13] Johansson E, Hammarskj?ld F, Lundberg D, et al. Advantages and disadvantages of peripherally inserted central venous catheters(PICC)compared to other central venous lines:a systematic review of the literature[J]. Acta Oncol,2013, 52(5):886-892.
[14] Perrin G. PICC placement in the neonate[J]. N Engl J Med, 2014, 370(22):2153-2154.
[15] Bai N, Sun C, Wang J, et al. Ertapenem versus ceftriaxone for the treatment of complicated infections:a meta-analysis of randomized controlled trials[J]. Chin Med J(Engl),2014, 127(6):1118-1125.
[16] Patel GS, Jain K, Kumar R, et al. Comparison of peripherally inserted central venous catheters(PICC)versus subcutaneously implanted port-chamber catheters by complication and cost for patients receiving chemotherapy for nonhaematological malignancies[J]. Support Care Cancer,2014, 22(1):121-128.
[17]岳芹,任珂.静脉输液港与PICC在乳腺癌化疗中的应用效果研究[J].临床医学研究与实践, 2017, 2(9):13-14.
[18] Kakkos A, Bresson L, Hudry D, et al. Complication-related removal of totally implantable venous access port systems:does the interval between placement and first use and the neutropenia-inducing potential of chemotherapy regimens influence their incidence? A four-year prospective study of 4045 patients[J]. Eur J Surg Oncol, 2017, 43(4):689-695.
[19]冷金华,廖志云,钟晓红. PICC置管异位的相关因素及纠正方法[J].河南医学研究, 2015, 24(2):150-151.
[20] Cape AV, Mogensen KM, Robinson MK, et al. Peripherally inserted central catheter(PICC)complications during pregnancy[J]. J Parenter Enteral Nutr, 2014, 38(5):595-601.
[21] Harter C, Ostendorf T, Bach A, et al. Peripherally inserted central venous catheters for autologous blood progenitor cell transplantation in patients with haematological malignancies[J]. Support Care Cancer, 2003, 11(12):790-794.
[22]蔡幼萍,戴晓霞.乳腺癌术后经PICC化疗引起血流感染2例[J].浙江实用医学, 2018, 23(1):66-67.