分时段中心静脉置管在极低出生体质量儿中的应用

Application of Combined Central Venous Catheterization in Divided Period in Very Low Birth Weight Infants

目的探讨分时段脐静脉置管和经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)置管在极低出生体质量儿中的应用效果。方法选取2010年1月—2011年12月入院的极低出生体质量儿111例,分为分时段应用脐静脉置管、PICC组(观察组)51例和外周静脉置管加PICC组(对照组)60例,监测两组住院期间的静脉置管情况、患儿身体指征反应及导管感染情况。结果观察组PICC 1次置管成功率高于对照组,输液外渗发生率低(P<0.01);两组患儿纠正低血糖所需时间差异无统计学意义;呼吸暂停次数、体质量增长至2 kg时间经比较差异有统计学意义(P<0.01)。结论采用分时段中心静脉置管具有穿刺成功率高,留置时间长,输液外渗发生率低,且不增加感染的优点,能最大限度发挥中心静脉置管的优势,为极低出生体质量儿提供了安全有效的静脉治疗通道,值得在临床中推广应用。

Objective To explore the application of umbilical venous catheter （UVC） combined with peripherally inserted central catheter （PICC） in divided period in very low birth weight infants （VLBWI）. Methods One hundred and eleven VLBWIs from January 2010 to December 2011 were divided into combined catheter group （UVC and PICC） with 51 cases and PIV （peripheral vein） plus PICC group with 60 eases. Venous catheter situation, physical indications and catheter infection during hospitalization were monitored. Results The one-shot success rate in combined catheter group was higher than that of PIV plus PICC group, but lower incidence of infusion extravasation in combined catheter group. Correction time of hypoglycemia had no significant difference between the two groups, however but the frequency of apnoea and the time of weight up to 2 kg had （P〈O.OI）. Oonclusion With combined central venous catheterization, a higher success rate of intravenous puncture could be achieved with longer retention time, but lower incidence of infusion extravasation, which provides a safe and effective venous channel for VLBWI.