脐静脉置管在极低或低出生体重儿的应用

Umbilical vein catheterization in very-low-birth-weight or low-birth-weight children

目的探讨脐静脉置管在极低或低出生体重儿的应用。方法对我科新生儿重症监护病房2011年6月至2013年1月进行脐静脉置管术的极低或低出生体重儿置管术后的临床情况进行总结。结果63例患儿均成功置管，其中成功置管于下腔静脉41例（65．1％）。留置时间4—21d，平均12．9d。留置导管期间非计划拔管11例，其中置管于脐静脉非计划拔管8例，不同置管位置的非计划拔管发生率差异有统计学意义（χ2=8．38，P〈0．01）。本组均在生后36h内插管，插管时间不同的患儿置管于下腔静脉成功率差异无统计学意义（χ2=0．223，P〉0．1）。置管期间5例发生疑似导管相关感染，感染率为6．2／1000血管内导管日，63例拔管后同时行导管末端培养和血培养，结果导管末端细菌培养阳性1例（1．6％），酵母样真菌阳性1例（1．6％），导管留置时间不同的患儿导管相关感染发生率的差异无统计学意义（χ2=0．075，P〉0．95）。结论脐静脉置管术可以在早产（极）低出生体重儿出生后早期应用。

Objective To probe the application of umbilical vein catheterization among the very- low-birth-weight or the low-birth-weight children. Methods In this retrospective study, the clinical condition of the very-low-birth-weight or the low-birth-weight infants in neonatal intensive care unit who had umbilical vein catheterization from June 2011 to January 2013 was concluded. Results Sixty-three cases were success- fully catheterized, of which 41 cases were catheterized in inferior vena cava（ 65.1% ）. The retention time was 4 to 21 days, with an average of 12. 9 days. Eleven cases suffered unplanned extubation of the indwelling catheters, and eight of them were located in the umbilical vein. There were statistically significant differences of unplanned extubation rates among different location of the catheters （ X2 = 8.38, P 〈 0. 01 ）. All cases were intubated within 36 hours after birth, and the intubation time was not positively correlated to the success rate of catheterization in the inferior vena cava （ X2 ~ 0. 223, P 〉 0. 1 ）. Suspected catheter-related infections occurred in 5 cases and the infection rate was 6. 2/1000 per intravascular catheter day. After extubation, bacterial cultures of the tips of the catheters and blood were arranged. The results suggest that the bacterial culture of the catheter tip was positive in only 1 case（ 1.6% ）, and yeast-like fungus was positive in 1 case （ 1.6% ）, while the retention time and incidence of catheter-related infection had no significant corelation（ ~2 = 0. 075, P 〉 0. 95 ）. Condusion Umbilical vein catheterization could be used at the early stage in preterm （ very ） low-birth-weight infants.