超声引导下经上臂贵要静脉和肱静脉穿刺行PICC的并发症比较研究

Comparison of complications of peripherally inserted central catheters between ultrasound-guided transhumeral basilic vein puncture and brachial vein puncture

目的探讨超声系统引导下的改良塞丁格技术(MST)选择肱静脉行经外周静脉穿刺置入中心静脉导管(PICC)置管术在临床患者中应用的可行性和并发症的发生率。方法回顾分析本院超声引导下经上臂贵要静脉和经肱静脉穿刺行PICC患者的临床资料,比较2种穿刺途径在并发症发生率上的差异,并试图找出并发症发生的独立危险因素。结果 2种置管途径在各种并发症发生率上均无统计学差异;非1次成功置管和非恶性肿瘤患者是PICC并发症发生特别是感染发生的独立危险因素。结论 超声引导下PICC穿刺可以避开血管内的不良因素,避开静脉瓣,从肘上较粗的肱静脉穿刺置管,减少了肘部运动时导管对血管壁的刺激以及导管在血管内外的进出,从而减少了血管相关性感染、机械性静脉炎等并发症的发生,尤其可以直接选择深静脉——肱静脉行PICC置管,既提高了PICC置管成功率,也保障了置管的安全性和有效性,值得临床推广应用。

Objective To explore the feasibility and complications of peripherally inserted central catheters （PICC） in patients with ultrasound- guided and MST- selected brachial vein puncture. Methods Clinical materials of PICC patients with ultrasound - guided transhumeral basilic vein puncture and brachial vein puncture were analyzed retrospectively. Incidence rate of complications between two types of puncture method was compared and the independent risk fac- tors of complications were discussed as well. Results There was no significant difference of inci- dence rate of complication between two type of catheterization. Non - primary successful catheteri- zation and non-malignant patients were independent risk factors for complications. Conclusion Ultrasound-guided PICC puncture can avoid the risk factors in blood vessels and venous valve. Paracentesis in brachial vein above the elbow can avoid the stimulation to the vascular wall and re- duce the incidence rate of catheter- related infection and mechanical phlebitis, and meanwhile it can increase the success rate of PICC catheterization and ensure the safety and effectiveness of catheterization, so it is worthy of clinical application and popularization.