经外周至中心静脉置管与传统中心静脉置管在老年病人中的应用

Comparison between PICC and CVC in the elderly

目的 :比较经外周静脉至中心静脉置管 (pcriphcrally inserted central catheters,PICC)与传统的经锁骨下静脉至中心静脉置管 (central venous cathetors,CVC)在老年病人临床应用中的优越性及并发症。 方法 :1988年 1月至 1999年 12月对 2 0例老年病人实施了 PICC,同时与 70例实施 CVC的老年病人进行对比分析 ,观察置管成功率和并发症发生率。 结果 :PICC与 CVC组穿刺置管成功率分别为 97.1%和 90 .0 % ,(χ2 =2 .97,P>0 .0 5 ) ;导管留置时间 PICC组 7～ 10 7天 ;中位数 (M) =14天 ;四分位间距 (Q) =2 5 .6 ;CVC组 8～ 90天 ;M=16天 ;Q=2 7.4;导管阻塞率分别为 11.4%和 4.2 % ;(χ2 =2 .47,P >0 .0 5 ) ;导管尖端误入颈内静脉 PICC组为 1.4% ,CVC为组5 .7% (χ2 =1.0 3,P>0 .0 5 ) ;导管感染率 PICC组为 1.4% ,导管尖端细菌培养和血培养阴性 ;CVC组为 2 .8% ,1例导管尖端细菌培养和血培养呈阳性 (χ2 =0 .34 ,P>0 .0 5 ) ;导管脱出 PICC组为 4.2 % ;CVC组为 1.4% (χ2 =1.0 3,P>0 .0 5 ) ;PICC组 3例 (4.2 % )发生外周静脉炎 ,CVC组有 2例 (2 .9% )发生气胸 ;CVC组有 7例穿刺置管失败病例改用 PICC方法均获成功 ,两组病人无深静脉血栓发生。 结论 :PICC具有置管成功率高 ,可以避免气胸、血管损伤等?

Objectives:To study the feasibility,complications,mid and long term advantages of peripherally inserted central catheters(PICC) compared with central venous catheters(CVC). Methods:From Jan.1998 to Dec.1999, 70 patients over 60 years old were placed with PICC lines and 70 patients over 60 years old were placed with central lines.Comparison items included tip placement and complication rates. Results:There were no significant differences between PICC and CVC in the success rate (97.1% and 90.0%,χ 2=2.07, P >0.05),the duration (7~107 days and 8~90 days),the occlusion rate (11.4% and 4.2%,χ 2=2.47, P >0.05),tip in the internal jugular vein (1.4% and 4.2%,χ 2=1.03, P >0.05) and catheter infection rate (1.4% and 2.8%,χ 2=0.34, P >0.05).Phlebitis occurred in 3 cases(4.2%) in PICC group,pneumothorax happened in 2 cases in CVC group.Calhelerization failure in CVC group was 7 cases who then received PICC successfully.No deep vein thrombosis occurred in either group. Conclusions:PICC has no possible severe complications of central venous access such as pneumothorax.The new method provides a safe,reliable and effective venous access for mid and long term usage in old patients.