综合干预预防乳腺癌PICC置管患者静脉炎的效果

Effect of comprehensive intervention on PICC-associated phlebitis in patients with breast cancer

目的 观察导管预处理和早期功能锻炼预防经外周静脉置入中心静脉导管（PICC）乳腺癌患者静脉炎的效果.方法 将46例行PICC的乳腺癌患者随机分为对照组（n=22）和干预组（n=24）.PICC置管前对照组使用100ml生理盐水,干预组使用地塞米松5 mg、利多卡因2ml和100 ml生理盐水混合液,浸泡3 min预处理导管；置管后对照组给予一般指导,干预组指导用握力器行握力训练,比较两组患者静脉炎发生率.结果 干预组静脉炎发生率8.3％,对照组27.3％,两组比较差异有统计学意义（x2 =4.217,P=0.031）；Ridit分析显示两组静脉炎严重程度比较差异有统计学意义（Z=-1.968,P=0.049）；干预组患者静脉炎发生时间为（92.0±26.5）h,对照组为（50.4±23.9）h,两组比较差异有统计学意义（t =2.863,P＜0.05）；两组患者观察30 d,干预组患者渗血发生率、导管长度与对照组比较,差异均无统计学意义（P＞0.05）,而手臂肿胀发生率低于对照组（P＜0.05）.结论 PICC置管前对导管进行药物浸泡预处理和置管后指导握力训练可降低静脉炎发生率及严重程度.

Objective To evaluate the preventive effect of catheters preconditioning and functional exercise on peripherally inserted central venous catheters （PICC）-associated phlebitis in patients with breast cancer.Methods Forty-six patients with breast cancer subjected to PICC were chosen and randomly divided into the control group （n =22） and the intervention group （n =24）.The catheters in control group were dipped into 100 ml normal saline for 3 minutes,while the catheters in intervention group were dipped into 100 ml normal saline which contained 5 mg dexamethasone and 2 ml lidocaine for 3 minutes before PICC.Patients in both groups were inserted PICC by standard procedure.After successful insertion,the control group received regular nursing,and the intervention group was asked to perform functional exercise by using pinch meter.The incidence,occurring time and severity of phlebitis as well as other complications were compared between the two groups.Results The incidence of phlebitis was 8.3% （2/24） in the intervention group,and lower than 27.3% （6/22） in the control group,and the difference was statistically significant （x2 =4.217,P =0.031）.The difference in the severity of phlebitis between the two groups was statistically significant （Z =-1.968,P =0.049）.The occurring time of phlebitis was （92.0 ± 26.5） h in the intervention group,and longer than （50.4 ± 23.9） h in the control group,and the difference was statistically significant （t =2.863,P 〈 0.05）.The incidence of arm swelling was 4.2% （1/24） in the intervention group,and lower than 22.7% （5/22） in the control group,the difference was statistically significant （P 〈 0.05）,and the incidences of other complications including bleeding and so on were not different in the two groups （P 〉 0.05） during 30 days.Conclusions Dipping the catheters into dexamethasone solution before insertion and performing functional exercise after insertion can reduce the incidence and severity degree of PICC-associated phlebitis.