超声引导联合腔内定位对新生儿PICC皮下血肿及静脉炎发生的影响

Effect of PICC localization guided by ultrasound combined with cavity electrocardiogram on subcutaneous hematoma and phlebitis

目的研究超声引导联合腔内定位对新生儿经外周置入中心静脉导管(PICC)皮下血肿及静脉炎发生的影响。方法采用前瞻性研究,将重庆市涪陵中心医院儿科2017年1月至2019年1月间收治的78例符合PICC指征的新生儿纳为研究对象,根据患儿入院序号将其分为联合组(超声引导联合心电图腔内定位,n=39)与X线定位(X线摄片定位,n=39)。比较两组置管成功率、置管异位率、导管穿刺时间、导管滞留时间、皮下血肿、静脉炎发生率,并采用医院自制量表,调查患儿家属满意度。结果联合组及X线定位组置管穿刺成功率分别为92.31%与87.18%,差异无统计学意义(P>0.05),置管异位率分别为7.69%与12.82%,差异无统计学意义(P>0.05);联合组导管穿刺时间明显短于X线定位组[(6.16±1.35)minvs.(13.46±2.13)min,P<0.05],两组导管滞留时间差异无统计学意义[(11.73±1.83)dvs.(11.46±1.79)d,P>0.05];联合组皮下血肿(2.56%)及静脉炎(2.56%)发生率均明显低于X线定位组(12.77%、14.89%),差异均有统计学意义(P<0.05);联合组患儿家属置管满意度为92.31%,显著高于X线定位组的74.36%(P<0.05)。结论超声引导联合心电图腔内定位能实现实时监测及调整对新生儿PICC穿刺,减少穿刺失误,降低皮下血肿及静脉炎发生率,在提高患儿治疗效果与家属置管满意度中具有积极意义。

Objective To investigate the effect of peripherally inserted central catheter(PICC)localization guided by ultrasound combined with cavity electrocardiogram on subcutaneous hematoma and phlebitis.Methods 78 newborns underwent PICC in Paediatrics Department of Fuling Central Hospital from January 2017 to January 2019 were prospectively enrolled,and divided into two groups according to the admission orders,each with 39 cases.PICC in combined group was guided by ultrasound combined with cavity electrocardiogram,while PICC in X-ray group was guided by X-ray.The success rate of catheterization,ectopic rate of catheterization,catheter puncture time,catheter retention time,subcutaneous hematoma,and the incidence of phlebitis were compared.A self-made scale was used to investigate the satisfaction of the parents.Results The catheterization success rate and catheter heterotopia rate were 92.31%and 7.69%in the combined group,and were 87.18%and 12.82%in the X-ray group(P>0.05).The catheter puncture time in combined group was(6.16±1.35)min,significantly shorter than that in the X-ray group[(13.46±2.13)min](P<0.05),and there was no significant difference in catheter retention time between the two groups[(11.73±1.83)d vs.(11.46±1.79)d,P>0.05].The incidence rate of both subcutaneous hematoma and phlebitis in the combined group was 2.56%,while the incidence of subcutaneous hematoma and phlebitis in the X-ray group was 12.77%and 14.89%,respectively.The satisfaction rate was 92.31%in combined group,which was higher than 74.36%in X-ray group,with statistic difference(P<0.05).Conclusion PICC localization guided by ultrasound combined with cavity electrocardiogram can effectively reduce the incidence rate of subcutaneous hematoma and phlebitis,which achieves high satisfaction rate.