肿瘤内科深静脉置管3930例临床应用分析

Clinical analysis of central venous catheter in 3930 patients with tumors

目的:探讨深静脉置管在肿瘤内科的用途及其价值,比较不同途径或方式的优劣。方法:选取盐城市肿瘤医院肿瘤内科八病区2000年7月31日—2013年7月31日住院患者中采用了4种深静脉置管的患者3 930例,经医生推荐结合患者意愿,其中采用经锁骨下中心静脉置管(CVC)3 859例、经外周静脉穿刺中心静脉置管(PICC)47例、经颈静脉CVC 15例、股静脉置管9例,从成功率、感染率、并发症和舒适度等几方面综合评价各置管方式的优劣。结果:(1)4种方式成功率:均高且较相似,以经锁骨下CVC稍优(99.25%,3859/3888)。(2)感染性并发症:以经颈静脉CVC最低(0%),经锁骨下CVC较低(2.31%,89/3859),PICC较高(17.02%,8/47),股静脉置管最高(22.22%,2/9)。(3)机械性并发症方面:发生率及严重性:以经锁骨下CVC最低最轻,经颈静脉CVC次之,PICC最高且较重,股静脉置管虽低但最重;发生种类:以经颈静脉CVC最少,股静脉置管较少,PICC较多,经锁骨下CVC最多。(4)感染性和严重机械性并发症(静脉血栓、静脉炎)总体情况:以经锁骨下CVC最优,经颈静脉CVC次之,其次为PICC,股静脉置管最差。(5)舒适度及患者可接受度:以经锁骨下CVC最优,PICC次之。(6)无并发症相关性死亡病例。结论:4种深静脉置管均为成熟技术,各有优劣,应酌情优选最佳途径互补应用,绝大多数情况下,以依次选择经锁骨下CVC、PICC、经颈静脉CVC、股静脉置管为宜。

Objective:To explore the value of central venous catheter(CVC)in clinical management of patients with various tumors,and to compare the advantages and disadvantages of various CVCs.Methods:Three thousand nine hundred and thirty patients admitted into the department of oncology at our hospital during July31,2000and July31,2013received four kinds of CVC,including subclavian central venous catheter,peripherally inserted central catheter CVC(PICC),transjugular CVC,and femoral vein catheterization.We compared the success rate,complications,comfort,costs,and some other aspects to evaluate the advantages and setbacks of each CVC,respectively.Results:(1)All kinds of CVC had a high success rate,while subclavian CVC demonstrated a slightly superior result.(2)The infectious complications were0%for transjugular CVC,21.31%for subclavian CVC,17.02%for PICC,and22.22%for femoral vein catheterization,respectively.(3)For mechanical complications,subclavian CVC had the lowest incidence,while PICC had the highest incidence.Transjugular CVC had few problems than the other three kinds,while subclavian CVC had more problems.(4)Infectious and severe mechanical complications(such as venous thrombosis,phlebitis):subclavian CVC had the lowest incidence,transjugular CVC followed,then PICC,and femoral vein catheterization had the highest incidence.(5)Comfort and acceptance by patients:Subcordic CVC had the most comfort and well accepted by patients,PICC comes in second.(6)No death associated with complications.Conclusions:Every kind of CVC had its advantages and disadvantages,and can be applied according to patient's situation and actual needs.Generally speaking,we suggest apply CVC as the following order:subclavian CVC,PICC,transjugular CVC,and femoral vein catheterization.