{"title":"风险分层护理干预对癌症患者picc相关血栓形成预防效果的准实验研究","authors":"Chun-Jie Sun, Li Ma, Su-Yun Wang, Qiu-Yun Xue","doi":"10.2147/RMHP.S521571","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To analyze risk factors for PICC-related thrombosis in cancer patients and assess the preventive efficacy of a risk-stratified nursing intervention based on these factors.</p><p><strong>Methods: </strong>This prospective observational cohort study evaluated the preventive effect of risk-stratified nursing on PICC-related thrombosis in cancer patients. Chemotherapy patients undergoing PICC placement in the oncology department of our hospital from January 2023 to December 2024 were enrolled. Participants were allocated into two cohorts based on the implementation timeline of the nursing protocol: Control group (n=117) received routine PICC care (January 2023-December 2023), while intervention group (n=119) received risk-stratified nursing interventions (January 2024-December 2024) guided by a logistic regression model identifying key thrombosis risk factors (eg, tumor staging, comorbid diabetes, D-dimer levels).</p><p><strong>Results: </strong>The intervention group (2024) exhibited a significantly lower PICC-related thrombosis incidence compared to the control group (2023) (4.20% vs 29.91%, χ²=28.436, P<0.001). Multivariate analysis identified tumor stage III/IV (OR=2.556, 95% CI 1.798-5.564), history of thrombosis (OR=19.273, 95% CI 10.674-37.561), diabetes (OR=2.572, 95% CI 1.027-5.712), catheter tip malposition (OR=14.339, 95% CI 8.916-29.795), and elevated D-Dimer (OR=9.528, 95% CI 6.703-15.597) as independent risk factors, while anticoagulant use (OR=0.449, 95% CI 0.089-0.874) was protective. In the intervention cohort, protocol-guided anticoagulation showed enhanced protection (OR=0.332, 95% CI 0.121-0.898, P=0.028). The intervention group also demonstrated improved quality of life across all SF-36 domains (eg, physical functioning: 58.94±1.97 vs 45.93±3.02, P<0.05) and significantly higher nursing satisfaction (96.64% vs 86.32%, χ²=8.091, P=0.004).</p><p><strong>Conclusion: </strong>Risk-stratified nursing interventions, guided by logistic regression analysis of thrombosis risk factors, significantly reduce PICC-related thrombosis incidence and improve patient quality of life and nursing satisfaction. This protocol offers a practical framework for oncology nursing to enhance patient outcomes.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"3209-3220"},"PeriodicalIF":2.0000,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477278/pdf/","citationCount":"0","resultStr":"{\"title\":\"A Quasi-Experimental Study on the Preventive Effect of Risk-Stratified Nursing Interventions for PICC-Related Thrombosis in Cancer Patients.\",\"authors\":\"Chun-Jie Sun, Li Ma, Su-Yun Wang, Qiu-Yun Xue\",\"doi\":\"10.2147/RMHP.S521571\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To analyze risk factors for PICC-related thrombosis in cancer patients and assess the preventive efficacy of a risk-stratified nursing intervention based on these factors.</p><p><strong>Methods: </strong>This prospective observational cohort study evaluated the preventive effect of risk-stratified nursing on PICC-related thrombosis in cancer patients. Chemotherapy patients undergoing PICC placement in the oncology department of our hospital from January 2023 to December 2024 were enrolled. Participants were allocated into two cohorts based on the implementation timeline of the nursing protocol: Control group (n=117) received routine PICC care (January 2023-December 2023), while intervention group (n=119) received risk-stratified nursing interventions (January 2024-December 2024) guided by a logistic regression model identifying key thrombosis risk factors (eg, tumor staging, comorbid diabetes, D-dimer levels).</p><p><strong>Results: </strong>The intervention group (2024) exhibited a significantly lower PICC-related thrombosis incidence compared to the control group (2023) (4.20% vs 29.91%, χ²=28.436, P<0.001). Multivariate analysis identified tumor stage III/IV (OR=2.556, 95% CI 1.798-5.564), history of thrombosis (OR=19.273, 95% CI 10.674-37.561), diabetes (OR=2.572, 95% CI 1.027-5.712), catheter tip malposition (OR=14.339, 95% CI 8.916-29.795), and elevated D-Dimer (OR=9.528, 95% CI 6.703-15.597) as independent risk factors, while anticoagulant use (OR=0.449, 95% CI 0.089-0.874) was protective. In the intervention cohort, protocol-guided anticoagulation showed enhanced protection (OR=0.332, 95% CI 0.121-0.898, P=0.028). The intervention group also demonstrated improved quality of life across all SF-36 domains (eg, physical functioning: 58.94±1.97 vs 45.93±3.02, P<0.05) and significantly higher nursing satisfaction (96.64% vs 86.32%, χ²=8.091, P=0.004).</p><p><strong>Conclusion: </strong>Risk-stratified nursing interventions, guided by logistic regression analysis of thrombosis risk factors, significantly reduce PICC-related thrombosis incidence and improve patient quality of life and nursing satisfaction. 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引用次数: 0
摘要
目的：分析癌症患者picc相关血栓形成的危险因素，并评价基于这些因素的分层护理干预的预防效果。方法：本前瞻性观察队列研究评估风险分层护理对癌症患者picc相关血栓形成的预防作用。入选于2023年1月至2024年12月在我院肿瘤科行PICC放置的化疗患者。根据护理方案的实施时间表，将参与者分为两组：对照组（n=117）接受常规PICC护理（2023年1月至2023年12月），干预组（n=119）接受风险分层护理干预（2024年1月至2024年12月），采用logistic回归模型识别血栓形成的关键危险因素（如肿瘤分期、合并症糖尿病、d -二聚体水平）。结果：干预组（2024）picc相关血栓发生率显著低于对照组（2023）（4.20% vs 29.91%, χ²=28.436）。结论：以血栓危险因素logistic回归分析为指导，进行风险分层护理干预，可显著降低picc相关血栓发生率，提高患者生活质量和护理满意度。该协议为肿瘤护理提供了一个实用的框架，以提高患者的预后。
A Quasi-Experimental Study on the Preventive Effect of Risk-Stratified Nursing Interventions for PICC-Related Thrombosis in Cancer Patients.
Objective: To analyze risk factors for PICC-related thrombosis in cancer patients and assess the preventive efficacy of a risk-stratified nursing intervention based on these factors.
Methods: This prospective observational cohort study evaluated the preventive effect of risk-stratified nursing on PICC-related thrombosis in cancer patients. Chemotherapy patients undergoing PICC placement in the oncology department of our hospital from January 2023 to December 2024 were enrolled. Participants were allocated into two cohorts based on the implementation timeline of the nursing protocol: Control group (n=117) received routine PICC care (January 2023-December 2023), while intervention group (n=119) received risk-stratified nursing interventions (January 2024-December 2024) guided by a logistic regression model identifying key thrombosis risk factors (eg, tumor staging, comorbid diabetes, D-dimer levels).
Results: The intervention group (2024) exhibited a significantly lower PICC-related thrombosis incidence compared to the control group (2023) (4.20% vs 29.91%, χ²=28.436, P<0.001). Multivariate analysis identified tumor stage III/IV (OR=2.556, 95% CI 1.798-5.564), history of thrombosis (OR=19.273, 95% CI 10.674-37.561), diabetes (OR=2.572, 95% CI 1.027-5.712), catheter tip malposition (OR=14.339, 95% CI 8.916-29.795), and elevated D-Dimer (OR=9.528, 95% CI 6.703-15.597) as independent risk factors, while anticoagulant use (OR=0.449, 95% CI 0.089-0.874) was protective. In the intervention cohort, protocol-guided anticoagulation showed enhanced protection (OR=0.332, 95% CI 0.121-0.898, P=0.028). The intervention group also demonstrated improved quality of life across all SF-36 domains (eg, physical functioning: 58.94±1.97 vs 45.93±3.02, P<0.05) and significantly higher nursing satisfaction (96.64% vs 86.32%, χ²=8.091, P=0.004).
Conclusion: Risk-stratified nursing interventions, guided by logistic regression analysis of thrombosis risk factors, significantly reduce PICC-related thrombosis incidence and improve patient quality of life and nursing satisfaction. This protocol offers a practical framework for oncology nursing to enhance patient outcomes.
期刊介绍：
Risk Management and Healthcare Policy is an international, peer-reviewed, open access journal focusing on all aspects of public health, policy and preventative measures to promote good health and improve morbidity and mortality in the population. Specific topics covered in the journal include:
Public and community health
Policy and law
Preventative and predictive healthcare
Risk and hazard management
Epidemiology, detection and screening
Lifestyle and diet modification
Vaccination and disease transmission/modification programs
Health and safety and occupational health
Healthcare services provision
Health literacy and education
Advertising and promotion of health issues
Health economic evaluations and resource management
Risk Management and Healthcare Policy focuses on human interventional and observational research. The journal welcomes submitted papers covering original research, clinical and epidemiological studies, reviews and evaluations, guidelines, expert opinion and commentary, and extended reports. Case reports will only be considered if they make a valuable and original contribution to the literature. The journal does not accept study protocols, animal-based or cell line-based studies.
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