암환자의 중심정맥관 삽입 예측요인
Factors Associated with Central Venous Catheterization in Cancer Patients
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초록
본 연구 결과 종양혈액내과에 입원한 암환자 중 중심정맥관 삽입을 통해 암치료를 받은 암환자는 82명(26.4%)이었으며, 나머지 279명(78.6%)은 말초정맥관을 삽입하여 암치료를 받았다. 말초정맥관 삽입군과 중심정맥관 삽입군의 일반적 특성을 비교한 결과, 성별과 거주지에 있어서는 통계적으로 유의한 차이가 없었으나, 평균 나이에서는 통계적으로 유의한 차이를 보였다. 질병 관련 특성에서는 평균 재원일수, 누적 재원일수, 진료과, 중심정맥관 삽입 경험, 암의 분류에서 통계적으로 유의한 차이가 나타났다. 반면, 평균 입원 횟수와 수술 과거력에 대한 두 군의 비교는 통계적으로 유의한 차이가 없었다. 영양 상태를 보면, 말초정맥관 삽입군과 중심정맥관 삽입군의 정상 체중비율, 정상 정상범위의 총림프구 수, 영양판정(정상/영양불량)에 있어 통계적으로 유의한 차이가 없었으나 혈중 알부민 수치에 있어서는 정상범위 여부에 따라 말초정맥관 삽입군과 중심정맥관 삽입군 간의 유의한 차이를 보였다. 이상의 결과에서, 로지스틱 회귀분석 결과 재원일수, 과거 중심정맥관 삽입 경험, 혈중 알부민수치의 정상수준 누적 재원일수, 혈액내과 질환이 중심정맥관 삽입 예측요인으로 나타났다.
Abstract
Purpose: The purpose of this study was to identify the types of venous access devices (VAD) for cancer patients and investigate the factors related to the insertions of central venous catheter (CVC) in cancer patients. Methods: The subjects were 379 cancer patients. A retrospective review of all patients who were discharged from a cancer unit from November 1st to 21st in 2008 was done using a structured questionnaire. Results: A total of 82 CVC (21.6%) was inserted among 379 patients for administering anticancer therapy. There were statistically significant differences in age, length of stay (LOS), cumulative LOS, medical department, history of CVC insertion,cancer category, and albumin level between patients using peripheral intravenous (IV) catheters and CVC. In addition, factors influencing the use of CVC were LOS (odds ratio [OR]=0.286, confidence interval [CI]=1.043-1.124), history of CVC insertion (OR=3.920, CI=0.128-0.637), albumin level (OR=1.010, CI=1.879-8.179), cumulative LOS (OR=1.010, CI=1.001-1.018), and hematological diseases (OR=4.863, CI=2.162-10.925). Conclusion: We found that central venous catheterization for anticancer therapy was minimal even though CVC was safe and effective device for IV access. It is necessary to develop a strategy to use VADs efficiently and timely for cancer patients.
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