经颈内静脉中心置管后改良固定技术的应用与效果观察

Application and effect observation on the improved internal jugular central venous catheter

目的探讨改良固定法在经颈内静脉穿刺中心静脉置管(CVC)中的价值。方法选择2012年7月-2013年12月在新疆维吾尔自治区人民医院胰腺外科、腹部创伤外科行颈内静脉置管的患者100例,随机分成试验组和对照组,每组各50例。试验组采用敷料覆盖区域常规备皮,去除多余毛发并清洁局部皮肤后置管,置管成功后,缝线固定加导管远心端朝下"∩"形摆放再加3M透明贴膜固定;对照组导管末端朝血管远心端放置,采用传统的缝线固定加3M透明贴膜固定。比较两组患者经颈内静脉穿刺中心静脉置管的导管脱出率、相关并发症发生率、平均留置时间及患者舒适度。结果试验组患者CVC脱出率(8%)和相关并发症的发生率(20%)均低于对照组(38%和72%),差异均有统计学意义(P<0.05),试验组患者的CVC平均留置时间长于对照组,舒适度高于对照组,差异有统计学意义(P<0.05)。结论经颈内中心静脉置管后改良固定技术具有降低导管脱出率、减少相关并发症的发生、延长导管平均留置时间和提高患者舒适度的作用,值得临床推广使用。

Objective To explore the clinical value of the “improved fixation method” in the internal jugular central venous catheter. Method 100 patients with internal jugular vein catheterization （2013.1--12） from Department of Pancreas Surgery in People＇s Hospital of Xinjiang Uyghur Autonomous Region were select- ed and randomly divided into experimental group （50 cases） and control group （50 cases）. The catheteriza- tion was conducted after the routine skin dressing, excess hair removal and local skin cleaning, with suture fixation on the catheter in the shape of ＂N＂ in the experimental group; The end of the catheter was placed toward the far end of heart blood vessel, with traditional suture fixation in the control group. Compare the unplanned extubation rate, local infection and patient comfort in two groups of patients with internal jugu- lar vein puncture in central venous catheter （CVC）. Results CVC emergence rate （8.0%） and the inci- dence of related complications （20.0%） in the experimental group were lower than those in the control group （38.0%, 38.0%）, with statistical significance （P 〈0.05） ; the average indwelling time and comfort of patients in the experimental group were higher than those in the control group （73.25%）, with statisti cally significance （P 〈0.05）. Conclusion The internal jugular central venous catheter with improved fixa tion technology proved to be effective in decreasing catheter emergence rate, reducing the incidence of re-lated complications, prolonging the average indwelling time and improving patients＇ comfort.