彩超引导下PICC置管在临终关怀患者中的临床应用

Clinical application of color Doppler guided by PICC catheterization in hospice patients

目的比较临终关怀患者彩超引导下PICC置管和盲穿PICC置管的穿刺效果和并发症发生情况。方法采用回顾性分析方法,选取2016年1月-2017年12月PICC置管的553例临终关怀患者为研究对象。将226例采用传统PICC盲穿的患者作为对照组,将其中327例采用彩超引导下PICC置管穿刺的患者作为观察组。比较两组的穿刺效果。结果两组患者PICC穿刺均以左侧为主,穿刺的血管主要为贵要静脉,其次为正中静脉;观察组一次性穿刺成功率为98.17%,对照组一次性穿刺成功率为91.15%,差异有统计学意义(P<0.001);观察组导管尖端位置位于上腔静脉或上腔静脉与右心房连接处的患者占92.97%,对照组为82.74%,差异有统计学意义(P<0.001);观察组置管时长明显少于对照组,差异有统计学意义(P<0.001);观察组有10.09%的患者出现了并发症,对照组为28.32%,差异有统计学意义(P<0.001)。结论临终患者由于长期输液置管等原因,血管较差,PICC置管难度较大,因此倡导临终关怀患者进行彩超引导下PICC置管,以提高穿刺成功率,减少并发症,提高患者生存质量。

Objective To compare the puncture effect and complications of the PICC catheterization and the blind PICC catheterization under the color Doppler guidance of the hospice patients.Methods A retrospective analysis was used.553 cases of hospice patients with PICC tube from January 2016 to December 2017 were selected.226 patients with traditional PICC blindness were divided into the control group,and 327 patients with PICC catheterization guided by color Doppler ultrasound were divided into experimental group.Compare the puncture effect of the two groups.Results The PICC puncture was mainly on the left upper limb;the blood vessels of the puncture were mainly the precious vein,and the second was the median vein.The successful rate of one time puncture was 98.17%in the experimental group and91.15%in the control group,with statistical difference(P<0.001).In the experimental group,the location of the catheter tip located in the superior vena cava or the superior vena cava and the right atrium was 92.97%,while that in the control group was 82.74%.The difference between the two groups was statistically significant(P<0.001).The length of the tube in the experimental group was significantly less than that of the control group,and the two groups had statistical difference(P<0.001).In the experimental group,10.09%of the patients had complications,the control group was 28.32%,and the two groups were statistically different(P<0.001).Conclusion Due to long-term infusion catheter and other reasons,terminal patients have poor blood vessels,PICC tube placement is difficult.Therefore,we advocate hospice care patients under color Doppler ultrasound guided PICC catheter,improve the success rate of puncture,reduce complications and improve the quality of life of patients.