气管切开患者不同部位中心静脉导管置管护理观察

Nursing Care of Patients with Tracheotomy Treated by Central Venous Catheter Inserted in Different Sites

目的：探讨气管切开患者不同部位中心静脉置管差异及临床意义。方法收集苏州大学附属第一医院2012年02月-2014年02月收治的75例气管切开患者临床资料，随机分为锁骨下静脉置管组（A组）、颈内静脉置管组（B组）、股静脉置管组（C组），每组25例。分别对穿刺成功率、并发症、穿刺部位血肿、渗液、导管堵管、脱出、导管相关感染、敷料更换频率等指标进行观察，比较各组之间差异。结果各组患者穿刺成功率及并发症差异无统计学意义（P＞0.05），其余各指标A组显著低于B、C两组，具有统计学意义（P＜0.05）。其中B组患者导管更易脱出，与A、C两组差异有统计学意义（P＜0.05）。结论气管切开患者选择锁骨下静脉置管具有较低的导管相关感染发生率，且便于护理治疗，应作为首选置管途径。

Objective To study the difference and clinical significance of patients with tracheotomy treated by central venous catheter inserted in different sites. Methods A total of 75 cases with tracheotomy from February 2012 to February 2014 were divided into three groups： subclavian vein group （group A）, jugular vein group （group B） and femoral vein group （group C）. 25 in each group. We compared the significance in success rates, complications, hematoma and exudate of puncture site, catheter tube jam, catheter emerge, central venous catheter-related infection （CVC-RI） and dressing change rates among all the groups. Results There was no significant difference of success rates and complications among all the groups （P〉0.05）, but group A was better than the other two groups in the targets （P〈0.05）. Central venous catheter was easier to emerge in group B compared with group A and group C （P〈0.05）. Conclusion Subclavian vein catheter way in the patients with tracheotomy has lower CVC-RI rate, and was easier for nursing care, so it was the first selection in the patient after tracheotomy.