超声引导下行上臂贵要静脉置入中心静脉导管的效果评价

Effect assessment of PICC catheterization through upper arm basilic vein guided by ultrasound

目的：探讨减少超声引导联合塞丁格技术行上臂贵要静脉PICC置管的并发症。方法选择2012年7月—2013年12月接受PICC置管患者400例,采用掷硬币法随机分为两组,对照组196例采用普通方法于肘窝处贵要静脉置管,观察组204例采用超声引导联合塞丁格技术上臂贵要静脉置管,比较两组患者置管过程疼痛感、一次置管成功率、导管相关感染、并发症。结果观察组一次置管成功率为99.50%,对照组为81.63%,两组比较差异有统计学意义（χ^2=38.06,P〈0.01）。观察组患者机械性静脉炎发生率为1.16%、静脉血栓为1.16%、导管破裂为0.58%,均低于对照组,差异有统计学意义（χ^2值分别为18.31,7.76,7.89；P 〈0.01）；对照组患者留置导管6个月期间平均维护、治疗费用为（1706.21±210.20）元,观察组为（1368.44±190.33）元,差异有统计学意义（t =15.47,P 〈0.01）。结论超声引导下上臂贵要静脉PICC置管能有效提高置管成功率、减少导管并发症、节约导管维护和治疗费用,值得临床推广。

Objective To investigate the reduction of ultrasound （ US） guided combined with Seldinger technique （ MST） for PICC catheter through upper arm basilica vein complications. Methods To select 400 patients received PICC from July 2012 to December 2013, they were divided into control group （n=196, using common methods in fossa cubitalis place to insert catheter to basilic vein） and observation group （ n =204, using ultrasound combined with MST for catheterization）. We compared the pain level during catheterization, the success rate of catheterization at first time, relevant infections and complications. Results The success rate of catheterization af first time was 99. 50% in the observation group and 81. 63% in the control group （χ^2 =38. 06,P 〈0. 01）, and 1. 16% of mechanical phlebitis, 1. 16% of venous thrombus and 0. 58% catheter rapture in the observation group lower than these of the control group （χ^2 =18. 31, 7. 76, 7. 89;P〈0. 01）. The maintenance and medical expenses of control group was （1 706. 21 ± 210. 20） Yuan while （1 368. 44 ± 190. 33） Yuan in the control group （t=15. 47,P〈0. 01）. Conclusions Ultrasound guided upper basilic vein PICC catheter can effectively improve the success rate of catheterization, reduce the complication of catheter, and save catheter maintenance and the cost of treatment, which is worth the clinical promotion.