不同冲管溶液对预防PICC置管期间血栓性静脉炎的效果研究

The Effect of Different Flush on Preventing Thrombophlebitis in Patients With Peripherally Inserted Central Catheters

目的:探讨肝素稀释液在预防PICC置管期间血栓性静脉炎的效果。方法:选择2006-2009年期间,在我科行PICC置管,排除凝血功能障碍及血液系统疾病的患者128例,随机分为实验组和对照组,实验组64例,在输液前后抽取肝素稀释液(浓度为10u/ml)5ml至10ml行冲管和正压封管,输液间歇期,用同样肝素稀释液5ml至10ml行冲管和正压封管,每周2次。对照组64例只用0.9%NS冲管和正压封管,方法与实验组相同。观察2组病人置管后1个月内发生静脉炎的临床表现、血浆钎维蛋白原(FIB)值的变化,并对有典型临床症状患者分别进行血液D-二聚体值及彩色多普勒超声检查。结果:对照组有明显静脉炎表现者13例,实验组6例,通过血D二聚体值测定和彩色多普勒超声检查显示,对照组13例患者中,9例患者符合血栓性静脉炎诊断标准,4例为非血栓性静脉炎,实验组的6例患者中,均不符合血栓性静脉炎诊断标准,血浆钎维蛋白原(FIB)值的变化,两组患者有显著差异。结论;用低浓度肝素稀释液冲管和封管,对排除凝血功能障碍及血液系统疾病的患者,可有效预防PICC置管期间血栓性静脉炎的发生。

Objectives：to assess the effectiveness of heparin dilution for prevention of PICC related thrombophlebitis.Methods： 128 patients who had PICC lines placed in our department during 2006-2009,without any coagulation disorders or haematological systemic diseases,were randomized divided into the trial group and the control group.64 patients in the trial group received 5-10 ml dilution of heparin sodium（10u/ml） as a flush before and after transfusion,as well as the intermission of transfusion（twice a week）,while 64 patients in the control only received 0.9% saline as a flush.Both groups were observed for the clinical manifestation of phlebitis for one month after catheter placed,and the change of plasma fibrinogen in each patient was recorded.The level of D-dimer in blood and the color Doppler ultrasonography were also tested in patients who had a typical clinical manifestation of phlebitis.Results：13 patients in control group and 6 patients in trial group appeared to have distinct catheter related phlebitis.The test of D-dimer in blood and the color Doppler ultrasonography proved that 9 patients in the control group met the diagnosis criterions of thrombophlebitis while other 4 patients were nonthrombophlebitis.But none of the 6 patients in trial group could meet the diagnosis criterions of thrombophlebitis.There was significant difference in the change of plasma fibrinogen between the two groups.Conclusion：Using low-concentration dilution of heparin as a flush and as a catheter aquaseal,can effectively prevent PICC related thrombophlebitis in patients who don＇t have coagulation disorders or haematologicat systemic diseases.