脐静脉置管联合经外周静脉置入中心静脉导管在极低出生体质量儿中的临床应用

Clinical application of umbili cal vein catheterization combined with peripheral central venous catheterization in very low birth weight infants

目的探讨应用脐静脉置管术(UVC)联合外周置入中心静脉导管术(PICC)在极低出生体质量儿(VLBWI)中的临床应用。方法总结53例UVC联合PICC置管(观察组)及28例周围静脉留置术(PIV)联合PICC置管(对照组)患儿的临床资料,分析比较2种方法在治疗中的优越性。结果观察组反复穿刺置管的次数显著低于对照组,穿刺点红肿、硬结、液体外渗、导管脱出低于对照组(P<0.05),PICC 1次穿刺成功率高于对照组(P<0.05),体质量最大下降占体质量的百分比、恢复出生体质量时间、恢复体质量后体质量增长、第2周体质量增长、矫正胎龄37周体质量增长百分比、体质量达到2 000 g时间观察组短于对照组(P<0.05),而第1周体质量增长观察组与对照组比较,差异无统计学意义(P>0.05)。结论 UVC适用于出生的早期,在危重儿住院初期的抢救治疗中更具实际意义。而PICC可在后期应用,为长时间的静脉营养提供支持,保证热卡的供给,从而达到追赶生长的目的。两种静脉通路的联合应用可达到理想的临床效果,值得在临床推广。

Objective To investigate the clinical application of umbilically inserted vein catheter(UVC)combined with peripheral central venous catheterization(PICC) in very low birth weight infants(VLBWI). Methods The clinical data of 53 patients with UVC combined with PICC catheterization(observation group) and 28 patients with PIV combined with PICC catheterization(control group) were summarized. The superiority of UVC combined with PICC catheterization and PIV with PICC catheter in their treatment was analyzed. Results The number of repeated puncture and catheterization in the observation group was lower than that in the control group significantly. The puncture point showed swelling,induration,fluid extravasation and catheter prolapse significantly lower than those in the control group(P <0.05). The success rate of PICC puncture was higher than that of the control group significantly(P <0.05),the percentage of body weight loss to body weight,the time of restoring birth weight,the body weight gain after weight recovery,the weight gain in the second week and the weight gain after 37 weeks of gestation,and the body weight of 2 000 g time observation group was significantly shorter than that of the control group(P <0.05). There was no significant difference between the observation group and the control group in the first week of weight gain(P >0.05).Conclusion UVC was applied to early stage of birth. In critically ill children hospitalized early rescue treatment more practical significance. The PICC can be applied later,to provide long-term support for intravenous nutrition,to ensure the supply of hot cards,so as to achieve the purpose of catching up for growth. The combination of the two venous pathways achieves the desired clinical outcome and is a safe and superior PIV-associated PICC technique that deserves promotion at the NICU.