156例神经外科静脉留置导管并发症的描述性研究

Descriptive study on complication after intravenous indwelling catheter in 156 neurosurgical cases

目的探讨神经外科病人静脉留置导管并发症的分布特点，为临床护理提供实证依据。方法以描述性研究的方法，回顾本院神经外科156例静脉留置导管的并发症资料，以非计划拔管、导管相关感染、导管堵塞、静脉栓塞、渗液、局部血肿为研究指标，探究并发症的发生与穿刺部位、导管类型的相关性。结果①1198例中发生并发症156例，发生率13．0％，其中非计划拔管94例、导管相关感染23例、导管堵塞19例、静脉栓塞6例、局部水肿5例、局部血肿9例。②并发症的构成比，以穿刺部位分：股静脉18．4％，颈内静脉7．2％，周围静脉6％。其中股静脉和颈内静脉的并发症差异有统计学意义（X^2=33．7，P〈0．01）；以导管类型分：双腔管17．9％，单腔管6．1％，PICC6．0％。其中双腔管和单腔管的并发症差异有统计学意义（X^2=-38．6，P〈0．01）。结论根据神经外科病人的特点，颈静脉穿刺较股静脉穿刺为好；单腔导管较双腔导管为好；急性期及手术病人尽量用深静脉导管；稳定期及长期输液的病人宜使用PICC。

Objective To explore the distribution of complications after intravenous indwelling catheter in neurosurgical cases. In order to provide theoretical basis for clinical nursing. Methods Complications after intravenous indwelling catheter in 156 neurosurgical cases were analyzed retrospectively. Unplanned extubation, catheter related sepsis, catheter obstruction, phlebothrombosis, fluid leakage, local hematoma were compared to study the correlation between the incidence of the complications and puncture point, the type of intravenous indwelling catheter. Results ① 156 cases among 1198 suffered from complications, the incidence was 13.0%. ② According to puncture point, the proportion in complications were as following： femoral venous catheterization was 18.4%, internal jugular venous catheterization was 7.2%, PICC was 6%. There was significant different between femoral venous catheterization and internal jugular venous catheterization （X^2=33.7, P〈0.01）. According to the channel of intravenous indwelling catheter, the two-lumen central venous catheterization was 17.9%, the central venous catheterization was 6.1%, PICC was 6.0%. There was significant different between the two-lumen central venous catheterization and the central venous catheterization （X^2=38.6, P〈0.01 ）. Conclusions According to characteristic .in neurosurgical patients, femoral venous catheterization was better than internal jugular venous catheterization, and the central venous catheterization was better than the two-lumen central venous catheterization. Deep venous catheterization was indicated for surgical operating patient or during acute stage. PICC was indicated for long-term intravenous fluid infusion patients or during stable stage