改良中心静脉穿刺术对穿刺置管并发症的影响

Effect of Improved Central Venous Catheterization on Preventing Complications after Catheterization

目的:探讨改良中心静脉穿刺置管预防置管后穿刺点渗血、导管意外脱落或移位的有效性和可行性。方法:选择拟行中心静脉穿刺置管的患者160例,随机分为改良组(G组)、常规组(C组),每组各80例。G组置入导引钢丝后不使用扩张子,直接沿钢丝放置中心静脉导管(central venous catheter,CVC),置管成功后"五点法"缝合固定CVC;C组使用扩张子扩皮后再置入CVC,置管成功后"三点法"缝合固定CVC。比较2组穿刺点出血、导管意外脱落或移位发生率。结果:G组59例、C组61例纳入统计学分析,渗血发生率和持续时间G组显著低于C组(P<0.01、P<0.05),皮下出血和(或)血肿、导管意外脱落发生率无显著性差异(P>0.05),G组导管移位发生率显著低于C组(P<0.01)。结论:不采用扩张子直接置入CVC和"五点法"缝合固定CVC可有效预防CVC置入后穿刺点渗血、导管意外脱落或移位。

Objective： To investigate the effectiveness and feasibility of improved central venous catheterization on preventing puncture site bleeding,catheter shedding and shift after catheterization. Methods： 160 patients undergoing central venous catheterization were randomly allocated to group G and group C,80 cases in each. Central venous catheter（ CVC） was inserted after dilator application in group C and without dilator application in group G. CVC was sutured by＂five-point method＂in group G and ＂three-point method＂in group C. The incidences of puncture site bleeding and catheter shedding and shift were compared between the two groups. Results： 59 patients in group G and 61 in group C were enrolled in the statistical analysis.The incidence and duration of bleeding in group G were significantly lower than those in group C（ P 0. 01,P 0. 05）; the incidences of subcutaneous hemorrhage / hematoma and catheter shedding had no significant differences between the two groups（ P 0. 05）; Catheter displacement rate in group G was significantly lower than that in group C（ P 0. 01）. Conclusion： Central venous catheterization using ＂five-point method＂without dilator application can effectively prevent puncture site bleeding and catheter shedding and shift after catheterization.