断流术患者围术期应用Power PICC安全性与可行性研究

Safety and feasibility study of applying Power PICC to devascularization patient in perioperative period

目的：评价断流术患者围术期应用Power PICC的安全性与可行性。方法2013年1月至2015年10月期间70例改良sugiura术患者,36例放置Power PICC（ A组）,34例放置CVC（ B组）。观察置管成功率、导管留置时间与导管相关并发症,分析影响导管相关并发症的危险因素。结果70例患者均置管成功。两组一般情况、手术情况、术中经PICC或CVC输液量无差异。导管留置时间A组显著长于B组（ P=0.002）,两组导管相关并发症无显著差异,A组无导管不适提前拔除病例,B组6例因导管不适予以提前拔除,两组差异显著（ P=0.01）。置管前PLT、PTA与WBC水平是影响穿刺部位出血与导管相关感染的独立危险因素。结论对于肝硬化门脉高压断流术患者,Power PICC能满足术中快速静脉输液需求,患者耐受性好,便于术后使用。对于PLT低于30×10^9/L,PTA低于65%,WBC低于2×10^9/L的患者,置管需持慎重态度。

Objective To evaluate the safety and feasibility of applying Power PICC to devascularization pa-tient in perioperative period. Methods For the 70 improved sugiura patients received from January, 2013 to Septem-ber, 2015, Power PICC was given to 36 patients （Group A） and CVC was given to 34 patients （Group B）. Cathetering success rate, catheter indwelling time and catheter related complication were observed to analyze the risk factors that in-fluence catheter related complications. Results Cathetering was successful to 70 patients. The general condition, opera-tion condition, operation with PICC or CVC infusion quantity of two groups had no difference. The catheter indwelling time of Group A was significantly longer than Group B （ P=0. 002 ） . The catheter related complications of the two groups had no significant difference. Group A did not have the patients removed in advance with catheter discomfort. 6 patients of Group B were removed because of catheter discomfort. The difference of the two groups was significant （ P=0. 01）. Before cathetering, PLT, PTA and WBC levels were the independent risk factors that influenced puncture part bleeding and catheter related infection. Conclusions For the devascularization patients of portal hypertension of liver cirrhosis, Power PICC can meet the requirement of rapid intravenous infusion during operation. The tolerance of patients is good, which is convenient for postoperative application. For the patients that PLT was lower than 30×109/L, PTA was lower than 65% and WBC was lower than 2×109/L, attention should be paid to cathetering.