钝性分离送鞘技术在低血小板计数血液病患者PICC置管中的效果观察

Effect of blunt separation and sheath delivery technique for PICC catheterization in patients with low platelet count hematopathy

目的探讨超声引导下改良塞丁格结合钝性分离送鞘技术在血小板计数极低血液病患者经外周置人中心静脉导管(PICC)置管中的应用效果。方法选择我院血液科收治的血小板计数低于20×10^9/L的血液病患者80例,随机分为干预组和对照组,每组40例。2组均采用超声引导下改良塞丁格技术进行置管,干预组采用钝性分离送鞘技术,对照组采用传统扩皮刀扩皮送鞘技术。比较2组患者一次送鞘成功率、送鞘完成时间、置管后并发症发生率和1周内维护次数等。结果干预组的局部出血量、渗血发生率、1周内维护次数均明显低于对照组(P<0.05);2组间一次送鞘成功率和送鞘完成时间差异均元统计学意义(P>0.05)。结论钝性分离送档特术能够改善血小板标数极低血液病患者PICC置管后的局部出血情况,值得临床推广。

Objective To explore the effect of modified Seldinger technique combined with blunt separation and sheath delivery under the guidance of ultrasonography in patients with extremely low platelet count with peripherally in- serted central catheter (PICC)implantation.Methods A total of 80 patients with hematological diseases whose platelet count was less than 20×10^9/L were selected from the Department of Hematology in our hospital,and were randomly divided into the intervention group and the control group,with 40patients in each group.Both of the two groups adopted the modified Seldinger technique under the guidance of ultrasound for intubation.The intervention group adopted the blunt separation and sheath delivery technique,and the control group adopted the traditional skin expanding knife technique.The success rate of primary sheath delivery,completion time,incidence of complications after intubation and the number of maintenance within 1 week were compared between the two axouns.Results The amount of local bleeding.the incidence of bleeding after intubationanathe number of maintenance in i week in theintervention goup were signifi-cantly lower than those in the control group (P <O.05).There was no statistically significant difference between the two groups in the success rate of primary sheath delivery and completion time (P>0.05).Conclusions The technique of blunt separation and sheath delivery can effectively improve the local bleeding after PICC catheterization in patients with extremely low platelet count,which is worthy of clinical promotion.