静脉营养液中加入肝素钠预防早产儿PICC导管堵塞的1例报告

Heparin Added in Total Nutrient Admixture for Preventing Peripherally Inserted Central Catheter Occlusion in Neonate:A Case Report

目的借助循证医学方法为1例经外周静脉穿刺中心静脉导管(PICC)输注全合一静脉营养液(TNA)的早产儿确定使用肝素钠预防PICC导管堵塞的治疗方案。方法在充分评估患儿的情况后,根据PICO原则提出临床问题,计算机检索Cochrane图书馆、Cochrane Central Register of Controlled Trials(CCTR)、Database of Abstracts of Reviews of E ects(DARE)、National Guideline Clearing-house(NGC)、MEDLINE(Ovid)和CBM,检索时限从建库至2011年,纳入有关新生儿PICC导管堵塞的随机对照试验和系统评价,对所获证据进行评价并结合早产儿的生理情况后确定临床干预方案。结果共检索出与问题相关的RCT 4篇,系统评价1篇。通过对检索结果进行分析并结合患者家属意愿,为患儿制定以下治疗方案:每1 mL营养液中加入0.5 U肝素钠作为降低PICC导管堵管率的方法。应用期间注意监测患儿血常规及凝血功能,并记录导管开放时间及拔管原因。经上述治疗后,患儿顺利完成治疗计划并拔管,PICC留置和开放时间均为20天,其间未发生PICC堵管、导管血栓形成及导管相关的血行感染。使用肝素钠后也未发生肝素钠导致的血小板减少症的相关症状与体征及凝血功能障碍加重。结论采用循证治疗方法,为早产儿使用肝素钠确定合理的治疗方案,可预防PICC导管堵塞,减少导管血栓形成、导管相关的血行感染风险,保证治疗的顺利完成,保障患儿安全。

Objective To make an individualized administration scheme via evidence-based medicine methods, namely adding heparin into the total nutrient admixture （TNA） solution, so as to help a neonate to prevent the occlusion of peripherally inserted central catheter （PICC）. Methods After carefully assessing the condition of neonate, this clinical issue was put forward in accordance with the PICO principles. Randomized controlled trials （RCTs） and systematic reviews on neonates＇ PICC occlusion were collected from The Cochrane Library, CCTR, DARE, NGC, MEDLINE （Ovid） and CBM from inception to 2011. The clinical intervention scheme was finally made after the assessment of the retrieved evidence and neonate＇s physiological condition. Results A total of 4 RCTs and 1 systematic review related to the issues were identified. The following scheme was finally made for the neonate through the assessment of the retrieved evidence and combination of intentions of the patient＇s family members： heparin （0.5 U/mL） was added into TNA to prevent PICC occlusion. During the application, blood routine test and blood coagulation were monitored, and the catheter opening time and extubation reason were recorded. Through the above treatment, the neonate successfully completed the treat- ment before extubation. The time of both PICC detaining and opening was 20 days in total, and there were no PICC occlusion, no catheter thrombosis, and no catheter related bloodstream infection. Moreover, no observation showed thrombopenia and aggravated coagulation disorders resulted from heparin. Condusion The evidence-based medicine method is an effective way to make reasonable heparin scheme for neonate, so as to prevent PICC occlusion, reduce catheter thrombosis, decrease risks of catheter related blood circulation infection, assure successful completion of treatment, and guarantee the safety of patients.