双腔Power PICC导管在呼吸危重症患者中的应用研究

Application of double lumen power PICC in patients with severe respiratory disease

目的:前瞻性评估双腔耐高压注射型经外周置入中心静脉导管(power peripherally inserted central catheter,Power PICC)临床应用于呼吸危重症患者的可行性。方法:选取2014年1月至2015年12月在重庆医科大学附属第一医院呼吸内科重症监护室(intensive care unit,ICU)进行经外周置入中心静脉导管(peripherally inserted central catheter,PICC)置管的患者187例作为研究对象,其中行双腔Power PICC置管患者100例,行三向瓣膜导管置管患者87例,前瞻性分析两组患者在一般资料、导管留置时间、住院时间、住院费用、患者满意度、护理工作量及导管相关并发症发生率方面的差异性。结果:2组患者在一般资料、导管留置时间、住院时间及住院费用方面无统计学差异;导管并发症方面:双腔Power PICC组导管断裂的发生率低于三向瓣膜导管,而堵管率及静脉血栓发生率略高于三向瓣膜PICC组,2组间差异无统计学意义;但双腔Power PICC导管可减轻患者反复穿刺的痛苦,故患者满意度高于三向瓣膜导管,两组间差异有显著统计学意义;由于三向瓣膜PICC组需要再次穿刺外周血管,导致输液相关并发症的发生率增高,故护理工作量高于双腔Power PICC组。结论:双腔Power PICC导管能满足呼吸危重症患者多通道连续给药、持续血流动力学监测、胃肠外营养、加强电子计算机断层扫描(computed tomography,CT)造影以及血标本的采集,尤其对于凝血功能障碍的患者具有突出的优势,值得在危重症患者中推广使用。

Objective：To prospectively evaluate the feasibility of clinical application of dual chamber high pressure injection type PICC power（central venous catheter）in respiratory and critical patients. Methods：Totally 187 patients in ICU of the department of respiratory medicine of the First Affiliated Hospital of Chongqing Medical University for PICC catheterization from 2014 January to December 2015 were taken as the research object including 100 cases using double channel power of PICC catheter and 87 cases using three directional valve catheter. The general information,catheter indwelling time,time of hospitalization,cost of hospitalization,the patient satisfaction and catheter related complications occurred rate of the two groups were prospectively analyzed. Results：There was no significant difference in the general information,catheter indwelling time,length of hospital stay and hospital costs between the two groups. Pipe blocking rate was lower in double channel power PICC catheter group than in three directional valve catheter group;incidence of venous thrombosis was higher in double channel power PICC catheter group than in three directional valve catheter group,but without significant differences. But the double channel power PICC catheter can reduce the pain of patients with repeated puncture,so the patient satisfaction was in double channel power PICC catheter group than in three directional valve catheter group with statisti-cal significance. As the three directional valve catheter group need to puncture the peripheral blood vessels,resulting in increased incidence of transfusion related complications,the nursing workload was heavier than that of double channel power PICC catheter group.Conclusion：Double channel power peripherally inserted central catheter can provide patients with continuous multi-channel administration,continuous hemodynamic monitoring,parenteral nutrition,strengthen the collection of CT angiography and blood samples. It has outstanding advantages,especially for patients with coagulation disorders. It is worth popularization and use in critically ill patients.