不同部位静脉留置针穿刺在先天性心脏病患儿输液中的效果

Effect of different puncture sites of vein indwelling trocar for infants with congenital heart disease

目的探讨先天性心脏病患儿不同部位给予静脉留置针穿刺的成功率及失败原因。方法将327例先天性心脏病患儿按随机数字表法随机分为颞浅静脉组106例、手背静脉组120例和大隐静脉组101例，分别在3个部位进行输液，比较3组留置针穿刺成功率及失败原因。结果颞浅静脉组穿刺成功率为92．45％，分别高于手背静脉组及大隐静脉组的80．83％，80．20％，差异均有统计学意义（X2分别为6．1518，6．3715；P〈0．05）；手背静脉组及大隐静脉组静脉留置针穿刺成功率比较，差异无统计学意义（P〉0．05）。3组患儿因患儿剧烈挣脱、退针过快、留置针质量问题、其他原因而导致的穿刺失败率比较，差异均无统计学意义（P〉0．05）；颞浅静脉组患儿因血管欠充盈而导致的穿刺失败率为0．00％，显著低于手背静脉组及大隐静脉组的7．50％，5．94％，差异均有统计学意义（x2分别为8．7048，6．9852；P〈0．01）；手背静脉组及大隐静脉组因血管欠充盈而导致的穿刺失败率比较，差异无统计学意义（P〉0．05）。结论在对先天性心脏病患儿进行留置针穿刺时，可优先选择颞浅静脉作为穿刺部位，以提高穿刺成功率。

Objective To compare successful rates among 3 different puncture sites of vein indwelling trocar for infants with congenital heart disease, and analyze failure reasons. Methods A total of 327 infants with congenital heart disease were randomly divided into 3 groups： the superficial temporal vein group with 106 cases, the dorsal hand vein group with 120 cases and the great saphenous vein group with 101 cases. The successful rates and influencing factors of these three groups were observed and analyzed. Results The successful puncture rate of superficial temporal vein group （92.45%） was higher than the dorsal hand vein group （ 80.83% ） and the great saphenous vein group （ 80. 20% ）, and the differences were statistically significant （X2 = 6. 151 8, 6. 371 5, respectively;P 〈 0.05 ）. The difference of successful rate between the dorsal hand vein group and great saphenous vein group was not statistically significant （ P 〉 0. 05 ）. The differences of failure rates among three groups due to infants＇ struggle, over-quick withdrawal, quality of indwelling needles and etc were all not statistically significant （ P 〉 0.05 ）. The failure rate in the superficial temporal vein group due to non turgor vitalis was 0.00%, obviously lower than that in the dorsal hand vein group （7.50%） and the great saphenous vein group（5.94% ）, and the differences were statistically significant （X2 = 8.704 8, 6.985 2, respectively ; P 〈 0. 01 ）. There was no significant difference of failure rates due to non turgor vitalis between the dorsal hand vein group and the great saphenous vein group （P 〉 0. 05）. Conclusions Superficial temporal vein should be considered as the first choice for infants with congenital heart disease who need vein indwelling trocar puncture, so as to improve the successful puncture rate.