口腔癌根治同期修复重建围手术期静脉通路选择

Selection of perioperative venous access for simultaneous repair and reconstruction of oral cancer after radical resection

目的探讨口腔癌根治术同期修复重建患者围手术期静脉通道的选择方式和深静脉置管相关并发症的预防措施,为口腔肿瘤患者围手术期的静脉治疗提供临床依据。方法对95例口腔癌根治术同期修复重建的患者围手术期内所使用的静脉通道及使用效果进行回顾性分析。结果95例患者术中均进行股静脉置管,术后结合中等长度导管或外周静脉留置针的应用顺利完成静脉治疗。股静脉置管并发症有下肢静脉血栓1例(发生率1.1%),穿刺口渗血17例(发生率17.9%),28例中等长度导管出现2例导管穿刺口渗血,外周静脉留置针的常见并发症是局部静脉炎和渗出,各类型导管并发症发生差异具有统计学意义(P<0.05),中等长度导管并发症发生率低于股静脉导管和外周静脉留置针。结论围手术期根据患者的治疗特点建立合适的静脉通道,术中予股静脉置管,术后结合中等长度导管和外周静脉留置针,可满足口腔癌根治术同期修复重建患者围手术期静脉治疗需要,中等长度导管相关并发症较少。

Objective To explore the characteristics of perioperative venous therapy in patients undergoing simulta-neous repair and reconstruction of oral cancer after radical resection,and prevention of femoral vein catheterization com-plications,to provide clinical evidence for venous therapy.Methods A retrospective analysis was perfomed to assess the choice of venous access and its effects in 95 patients undergoing simultaneous reconstruction due to oral cancer dur-ing the perioperative period.Results In total,95 patients underwent successful indwelling femoral vein catheterization with double lumens,and a midline catheter and peripheral intravenous indwelling needles were used to complete the in-travenous therapy after surgery.Among the femoral vein complications,1 case was complicated with lower extremity ve-nous thrombosis(incidence was 1.1%),and 17 cases were complicated with puncture point bleeding(incidence was17.9%).Two cases of puncture site bleeding were noted among 28 cases using a midline catheter.Local phlebitis and infiltration were the most common complications of peripheral venous catheters.The difference in catheter-related complications among different types of catheters was statistically significant(P<0.05).The complication rate of the midline catheter was lower than that noted with femoral vein catheterization and peripheral intravenous indwelling nee-dles.Conclusion Based on the treatment characteristics of patients,proper venous catheters should be established during the perioperative period.The application of a femoral vein catheter during the operation combined with the use of a midline catheter and peripheral venous indwelling needles after the operation can satisfy intravenous therapy needs in patients undergoing simultaneous repair and reconstruction for oral cancer,and the midline catheter can effectively reduce venous catheter-related complications.