经外周置入中心静脉导管在危重新生儿中的应用研究

Clinical study on the application of peripherally inserted central catheters for critically ill neonates

目的研究经外周置入中心静脉导管（PICC）应用于危重新生儿作为中长期静脉通道的留置时间、完成治疗情况以及并发症发生率及处理,体重与插入导管长度的关系等。方法对2002年1月-2006年3月在NICU中所有置入的PICC进行前瞻性研究,详细记录研究期间NICU中应用PICC导管患儿的临床资料,并对资料进行统计分析。结果研究期间有502位新生儿共置入PICC导管507根,提供静脉营养、抗感染治疗或应用血管活性药物是放置PICC导管的常见原因,导管平均使用时间为15.53 d。完成治疗或因出院（包括放弃治疗或死亡的患儿）拔除导管为正常拔管组,共423例,占84.43%。因各种并发症拔管者84例,占总数的16.57%。不同静脉置管导管尖端异位的发生率有显著差异,导管相关性血流感染的发生率为2.16/1 000导管日。总结了不同体重患儿在不同部位置管时导管插入长度的参考值。结论PICC导管为危重新生儿尤其是极低出生体重儿提供了可靠安全的中长期静脉通道,较低的并发症使其更易被临床医务人员及家长所接受。

Objective To study the catheter features such as catheter life, completion of therapy, complications and the correlation between the weight of infant and the length of catheter for critically ill neonates treated with PICC in NICU. Method A prospective study for all PICC inserted in the NICU at the children＇s Hospital for four years. All clinical data of infant with PICC was collected and analyzed. Result 507 PICC were inserted among ,502 infants. Providing nutrition, anti-infection treatment and applying vasoactive medication was the common reason for PICC insertion. Average catheter life was 15.53 days. Completion of therapy was achieved in 84.43% （423 cases）. 16.57% （84 cases） PICC were removed for complication. The rate of catheter-related bloodstream infection was 2.16/1000 catheter days. The proportion of non-central location of the catheter tip was significantly difference between the veins for insertion. The reference of catheter length for insertion was suggested according the infant weight in different vein. Conclusion PICC provides reliable and safe access for prolonged IV therapy in critically ill neonates and very low birth weight infants. The low incidence of complication with PICC makes them an attractive device for prolonged Ⅳ access.