两种穿刺置管术治疗消化系肿瘤患者并发症的比较

Clinical effect of improved subclavian vein catheterization versus internal jugular vein catheterization in patients with alimentary canal neoplasms

目的:观察改良式锁骨下静脉置管术在消化系肿瘤患者临床治疗中的效果及应用价值.方法:对130例需要进行深静脉置管的消化系肿瘤患者进行不同置管术的临床观察,观察组给予改良式锁骨下静脉置管术,对照组给予颈内静脉置管术.观察比较两组置管成功率、导管留置时间、敷贴更换次数、患者不适感、患者偏爱、导管相关性感染、导管异位、误穿动脉等情况.结果:两组置管术均有较高的成功率,观察组为98%,对照组为100%,两组差异无统计学意义(P>0.05).观察组置管成功64例,平均导管留置时间19.7d±5.2d,更换敷贴平均次数2.6次/wk±0.7次/wk,13例患者治疗期间发生不适;对照组置管成功65例,平均导管留置时间11.5d±4.2d,更换敷贴平均次数3.7次/wk±1.1次/wk,49例患者治疗期间发生不适.上述资料除置管成功例数外,差异均有统计学意义(P<0.05).此外,在比较导管相关性感染、导管异位、误穿动脉、心率失常、气胸、穿刺点渗血或渗液等并发症方面,观察组均优于对照组(P<0.05).结论:对消化系肿瘤临床治疗中采用改良式锁骨下静脉置管术,具有留置时间长、并发症少等特点,值得临床推广.

AIM：To evaluate the clinical effect and application value of improved subclavian vein catheterization in patients with alimentary canal neoplasms.METHODS：One hundred and thirty patients with alimentary canal neoplasms who required deep vein catheterization were divided into either an observation group or a control group.The observation group underwent improved subclavian vein catheterization,while the control group underwent internal jugular vein catheterization.The success rate of catheterization,catheterization time,applicator replacement times,patient discomfort,patient preference,catheterization-related infections,catheter migration,and inadvertent arterial puncture were compared between the two groups.RESULTS：Both groups had a high success rate of catheterization,and there was no significant difference in the success rate of catheterization between the two groups（98% vs 100%,P 0.05）.The average catheterization time（19.7 d ± 5.2 d vs 11.5 d ± 4.2 d,P 0.05）,average applicator replacement times（2.6 times/wk ± 0.7 times/wk vs 3.7 times/wk ± 1.1 times/wk,P 0.05）,and the number of patients developing treatment discomfort（13 vs 65,P 0.05） differed significantly between the observation group and control group.In addition,the incidences of catheter-related infections,catheter migration,inadvertent arterial puncture,cardiac arrhythmia,pneumothorax,puncture site bleeding or exudate were better in the observation group than in the control group（all P 0.05）.CONCLUSION：Compared to internal jugular vein catheterization,improved subclavian vein catheterization is associated with longer catheterization time and fewer complications in patients with alimentary canal neoplasms.