极低及超低出生体质量儿脐静脉导管2种不同固定方法的效果比较

Comparison of two different fixation methods of umbilical venous catheter for very low and extremely low birth weight infants

目的探讨2种不同脐静脉导管固定方法在极低及超低出生体质量儿中的应用效果。方法新生儿重症监护病房2016年12月—2017年10月收治的行脐静脉导管置入的新生儿33例为研究对象,根据脐静脉导管固定方法不同分为2组。对照组16例采用外科手术荷包缝合加无纺胶布搭桥固定方法固定导管,改良组17例采用脐带结扎包内气门芯套在脐带根部,并以7号丝线代替气门芯尾线缠绕导管进行正反面环形打结数周后固定导管,外露导管环形放于脐旁,应用水胶体敷贴覆盖固定。比较2种脐静脉导管方法的固定效果。结果 2组均未出现导管脱出、插管过深、拔管后出血病例。2组置管后留置时间、感染、局部渗血、腹胀、拔管困难等并发症发生率差异均无统计学意义(P>0.05)。改良组医用粘胶相关性皮肤损伤发生率低于对照组(P<0.05)。结论改良后固定方法不易发生导管脱落及医用粘胶相关性皮肤损伤,不增加置管相关并发症,且操作简单,值得推广。

Objective To evaluate two different methods of umbilical venous catheter fixation for very low(VLBW)and extremely low birth weight(ELBW)infants.Methods Thirty-three VLBW or ELBW infants in total undergoing umbilical venous catheterization were assigned to the control group(n=16)and the intervention group(n=17)according to the fixation methods.In the control group,the method of purse-string suture combined with non-woven adhesive plaster was used to fix the catheter.In the intervention group,the method of round suturing combined with hydrocolloid dressing was used to fix the catheter.Results There was no infant with catheter dislocation,excessive catheter placement or hemorrhage after catheter removal in both two groups.There was no significant difference in incidence of catheter indwelling time,infection,local hemorrhage,abdominal distension or difficulty of catheter removal between two groups(P>0.05).The incidence of medical adhesive-related skin injury was lower in the intervention group than that of the control group(P<0.05).Conclusion The modified fixation methods is potentially effective to prevent the dislocation of umbilical venous catheter and medical adhesive-related skin injuries in VLBW or ELBW infants undergoing umbilical venous catheterization.