高频超声引导经上臂行中心静脉置管术的临床应用

Clinical application of upper arm placement of PICC using high-frequency ultrasound guidance

目的探讨高频超声引导经上臂静脉运用改良塞丁格技术行外周静脉穿刺中心静脉置管术(PICC)的临床应用价值。方法对300例拟实施上臂静脉穿刺PICC置管的患者,根据肘部血管条件分为对照组136例(传统盲穿法)和超声组164例(高频超声实时引导下穿刺)。比较两组穿刺成功率、置管成功率及并发症发生率。结果超声组一次穿刺成功161例(98.17%),二次及二次以上成功3例(1.83%),穿刺失败0例;对照组一次穿刺成功115例(84.56%),二次及二次以上成功13例(9.56%),穿刺失败8例(5.88%);超声组一次置管成功158例(96.34%),对照组一次置管成功103例(75.74%);两组一次穿刺成功率、穿刺失败率及一次置管成功率的差异均有统计学意义(P<0.01)。超声组出现并发症24例,对照组57例(P<0.01),两组局部血肿、局部感染、静脉炎及血栓形成发生率的差异均有统计学意义(P<0.05)。结论高频超声引导经上臂静脉运用改良塞丁格技术行PICC相对于传统盲穿法置管简便、安全、成功率高,并发症少,有重要的临床应用价值。

Objective To discuss the clinical application of upper arm placement of peripherally inserted central catheters （PICC） using highfrequency ultrasound guidance and modified Seldinger technique. Methods A total of 300 pa tients who intended to receive upper arm placement of PICC were divided into two groups： the control group（n=136） and the ul trasound group（n=164）. The control group underwent the blind puncture of bodysurface localization while the ultrasound group underwent realtime highfrequency ultrasoundguided puncture. The first achievement ratio of puncture and catheterization and the incidence rate of complications were observed. Results As to the ultrasound group, the first achievement ratio of punc ture, second and more times＂ achievement ratio of puncture and the failed cases were respectively 161 cases （98.17%）, 3 cases （1.83%） and 0（0%）, whereas the ratios in the control group were respectively 115 cases （84.56%）, 13 cases （9.56%） and 8 cases （5.88%）. According to the first achievement ratio of puncture and catheterization and the failure rate, there were statisti cal significances between the two groups （P〈0.01）. The numbers of the cases that occured complications were respectively 24 cases and 57 cases. According to the incidence rates of local hematoma, local infection, phlebitis and thrombosis, there were statistical significances between the two groups （P〈0.05）. Conclusion Upper arm placement of PICC using highfrequency ultrasound guidance is easy and safe with high achievement ratio and lower incidence rate of complications, in comparison to traditional blind procedure. It has significant value of clinical application.