视锐 V超声直视下前置局麻在 PICC 置管中的应用

Application of the local pre-analgesia on the PICC catheter under the direct vision of site-rite V ultrasonic

目的：探讨视锐V超声直视下前置局麻方法在PICC置管中的止痛效果，为PICC置管患者提供超前镇痛，实现置管全程的无痛护理。方法选择行视锐V超声引导下结合改良塞丁格技术行PICC置管的患者60例，采用随机数字表法随机分为观察组和对照组，每组各30例。观察组穿刺前利用视锐Ⅴ血管超声仪直视靶血管使用0．2％利多卡因0．3 ml行皮下局部浸润麻醉，对照组经皮穿刺后扩皮前再行0．2％利多卡因0．3 ml皮下局部浸润麻醉。比较两种麻醉方式下患者疼痛指数、置管过程中的患者感受程度和患者满意度。结果观察组患者置管全程疼痛评分平均为（5．29±2．89）分，对照组为（5.77±2．34）分，两组比较差异有统计学意义（t＝-0．710，P＜0．05）。观察组患者静脉穿刺感受评估级别低于对照组，穿刺部位短暂的刺痛感受患者20例，对照组3例，两组比较差异有统计学意义（ Z＝-4．743，P＜0．05）。观察组患者满意度为73．3％，对照组为53．3％，两组比较差异有统计学意义（χ2＝199．000，P＜0．01）。结论视锐V超声直视下超前镇痛局麻方法在PICC置管中能准确有效的对穿刺局部进行麻醉，缓解置管过程中的疼痛，改善置管过程患者舒适度，提高患者置管满意度。

Objective To explore the analgesic effect of local pre-analgesia on the peripherally inserted central catheter （ PICC ） catheter under the direct vision of site-rite V ultrasonic in order to provide the preemptive analgesia for PICC catheter patients and come true the painless nursing during the PICC catheter . Methods Sixty patients with the PICC catheter under the direct vision of site-rite V ultrasonic combined by the MST technology were chosen and divided into the observation group and the control group according to the random number table , each with 30 cases.The observation group received the subcutaneous local infiltration anesthesia in blood vessels through 0.3 ml of 0.2% lidocaine under the direct vision of site-rite V ultrasonic before the puncture , and the control group received the subcutaneous local infiltration anesthesia through 0.3 ml of 0.2%lidocain after the percutaneous puncture and before the skin expansion .The pain index , the degree of feeling during the PICC catheter in the patients and patients ’ satisfaction were compared between two groups . Results The score of pain during the PICC catheter was （5.29 ±2.89） in the observation group, and was （5.77 ±2.34） in the control group, and the difference was statistically significant （t=-0.710,P〈0.05）. The assessment grade of puncture feeling in the observation group was lower than that of the control group ;and the cases of patients with short sharp pain feeling in the puncture location were 20 cases in the observation group, and were 3 cases in the control group, and the difference was statistically significant （Z=-4.743,P〈0.05）.The patients’ satisfaction was 73.3%in the observation group , and was 53.3% in the control group, and the difference was statistically significant （χ2 =199.00,P〈0.01）.Conclusions The local pre-analgesia under the direct vision of site-rite V ultrasonic during the PICC catheter can accurately and effectively carry out the local anesthesia in the puncture location , and relieve patients ’ pain during the PICC catheter , and improve patients’ comfort, and increase patients ’ satisfaction.