三种PICC穿刺方法在儿童肿瘤置管中的比较

The Comparison of Three Methods of PICC Puncture in the Children's Tumor Catheter

目的：通过三种PICC穿刺方法在儿童肿瘤疾病中置管的应用，比较三种穿刺方法的一次性穿刺成功率、患儿疼痛感、相关并发症的发生情况，为选择合适的PICC穿刺方法提供依据。方法：选取2013年2月-2014年2月经确诊疾病行化疗的47例患儿作为研究对象，年龄3-13岁，采用美国巴德公司4 F规格的PICC导管，其中28例使用盲穿法（A组）、12例使用非超声引导下改良塞丁格技术（B组）、7例留置针改良塞丁格技术（C组）行PICC置管术。观察比较三种穿刺方法的一次性穿刺成功率、患儿疼痛情况、相关并发症的发生情况。结果：A组的一次性穿刺成功置管率为71.43%，B组的一次性穿刺成功置管率为91.67%，C组的一次性穿刺成功置管率为100%，三组PICC一次性穿刺成功置管率的比较差异有统计学意义（χ2=4.170， P=0.0243）。三组患儿疼痛情况的比较差异有统计学意义（P〈0.05）。3组PICC置管术后机械性静脉炎、渗血的发生率比较差异均有统计学意义（P〈0.05），而三组体外断管的发生率比较差异无统计学意义（P〉0.05）。结论：在置管过程中运用留置针改良塞丁格技术更适用于儿童的PICC置管。

Objective： To provide the basis for the selection of suitable PICC puncture method in childhood cancer disease by comparing one-time puncture success rate,children with pain,complications related of three kinds of PICC puncture method.Method：A total of 47 children who were diagnosed diseases undergoing chemotherapy from February 2013 to February 2014 were selected as research objects,aged 3-13 years old,they were punctured by PICC catheter America budd Company 4F specifications,28 cases were treated with blind approach（group A）,12 cases were treated with under the guidance of modified Seldinger technique non ultrasound（group B）,7 cases were treated with catheter modified Seldinger technique（group C）.The venipuncture success rate,children with pain and complications related of the three methods were observed and compared.Result：Disposable puncture success rate of catheterization in group A was 71.43%,disposable puncture success rate of catheterization in group B was 91.67%,disposable puncture success rate of catheterization in group C was 100%,there was statistically significant in disposable puncture success rate of catheterization of the three groups（χ2=4.170,P=0.0243）.There was significant difference on pain in three groups（P〈0.05）. There were significant differences on the incidence of mechanical phlebitis,blood oozing in three groups（P〈0.05）,and there was no significant difference in the incidence of tube（P〉0.05）.Conclusion：In the process of inserting tubes using indwelling needle modified Seldinger technique is more suitable for children with PICC catheter.