外周导入中心静脉置管用于血液肿瘤化疗的临床观察与护理的研究

Randomized Control Study for Assessing the Clinical Effects and Nursing of chemotherapy administration by placement of peripherally inserted central venous catheter in hematological malignancies

目的 为病人建立良好的静脉通路，减轻化疗药物的渗漏和对病人血管的损伤，探讨行之有效的静脉通路。方法 采用随机对照的研究方法，分别观察血液肿瘤病人中16例用外周导人中心静脉置管术(PICC)(Ⅰ组)、19例用锁骨下静脉置管术(Ⅱ组)和18例用浅静脉穿刺术置管(Ⅲ组)输注化疗药物的临床效果和护理特点。结果(1)Ⅰ、Ⅱ、Ⅲ组一次穿刺成功率分别为93.8％、89.5％和94.4％(P＞0.05)；(2)Ⅰ、Ⅱ、Ⅲ组发生药物渗漏和／或脉管炎的比率分别为6.3％、15.8％和22.2％(P＜0.05)；(3)Ⅰ、Ⅱ、Ⅲ组留管中位时间分别为78d、31d和5d(P＜0.001)；(4)置管时与留管期间病人有心理恐惧和／或焦虑的Ⅰ、Ⅱ、Ⅲ组分别为12.5％、42.1％和16.7％(P＜0.001)；(5)3组均未因置管发生感染和栓塞。结论PICC操作简单、安全、创伤小、留置时间长，且感染及栓塞机会低，能提高护理质量、值得临床推广应用。

Objective To assess whether peripherally inserted central catheters (PICC) can provide a safe and reliable method of chemotherapy administration and whether it can avoid the suffering of superficial vein puncture again and again in patients with hematological malignancies. Method A randomized control study was applied to investigate the conditions of chemotherapy administration and nursing in(ⅰ) 16 cases with PI CC(Ⅰ group), (ⅱ) 19 cases with subclavical vein catheter(Ⅱ group) and (ⅲ) 18cases with superficial vein catheter(Ⅲ group). Results (1) The achievement ratios of once puncture for Ⅰ, Ⅱ and Ⅲ group were 93.8%, 89.5% and 94.4% respectively(P>0.05). (2) The ratios of drug-leakage and/or angitis for those three groups were 6.3%, 15.8% and 22.2% respectively (P<0.05). (3) The median duration of PICC group was 78 days, that of subclavical vein catheter group was 31 days and it was 5 days in superficial vein catheter group. (4) The ratios of that patients suffered from psycho-fear and/or anxiety at the time of puncture and the catheters durations were 12.5%, 42.1% and 16.7% for Ⅰ, Ⅱ and Ⅲ group respectively(P<0.001). (5) There were no infections and embolisms for those three groups. Conclusion PICC may improve quality of care and embolisms for those three patients who need long-term transfusion or chemotherapy for its simple operation, safety, little trauma, a long duration and little psycho-fear or anxiety resulting from patients.