脐静脉置管137例临床分析

Clinical Analysis on 137 cases of Umbilical Venous Catheterization

目的探讨脐静脉置管在新生儿重症监护室的临床应用。方法对我科新生儿重症监护病房2011年7月至2012年12月脐静脉置管情况进行回顾性分析。结果 137例新生儿进行了脐静脉置管,134例（97.8%）为极低或超低出生体质量儿,另外3例为Rh血型不合溶血病换血1例、难治性低血糖1例和重度窒息复苏1例。106例（77.4%）导管位置在右心房和下腔静脉连接处,正常使用7~14d,27例（19.7%）置管不顺利,留置深度在4~5cm,短期使用3~5d,4例（2.9%）置管失败。133例送检导管末端培养,5例（3.8%）导管末端细菌培养阳性,血培养为同一细菌生长3例（2.3%）。5例阳性导管留置时间均较长,置管平均时间10.8d。结论脐静脉置管是新生儿重症监护的重要技术,用途广泛,尤其在极低和超低出生体质量儿出生早期（7~10d）可以推广使用。

Objective To investigate the state of umbilical venous catheterization in neonatal intensive care unit of Suzhou Municipal Hospital. Methods Analyze retrospectively of umbilical venous catheterization in neonatal intensive care unit from July 2011 to December 2012. Results 137 infants had umbilical venous catheterization. 134 （97.8%） cases were extremely low birth weight infants and very low birth weight infants, and other 3 cases were Rh blood group incompatibility, persistent hypoglycemia and severe asphyxia. Umbilical venous catheter tip position reached the adjunction of right atrium and inferior vena cava in 106 （77.4%） cases and the duration of catheterization were 7 to 14 days, 27 （19.7%） cases were not in good position and catheters kept in depth of 4 to 5cm for a short period use of 3 to 5 days, 4 （2.9%） cases of umbilical venous catheterization were failed. All catheter tips were sent for organism culture, 5 （3.8%） cases were positive and there were 3（2.3%） cases got the same bacteria growing in blood culture at same time. The average duration of catheterization in the 5 cases was 10.8 days which was little longer than the average duration. Conclusions Umbilical venous catheterization is an important technic in neonatal intensive care, which is routinely used in various conditions, especially in extremely low birth weight infants and very low birth weight infants as central venous for 7 to 10 days.