钝性扩皮送鞘降低外周静脉置入中心静脉导管相关并发症的临床研究

Blunt separation method reducing complications of peripherally inserted central catheter:a clinical study

目的探讨钝性扩皮送鞘降低超声引导联合改良赛丁格技术(MST)经外周静脉置入中心静脉导管(PICC)相关并发症的临床价值。方法将230例行PICC置管的患者按照随机数字表生成的随机码分为观察组和对照组,各115例。观察组采取钝性扩皮送鞘,对照组采取手术刀片扩皮送鞘。比较两组患者一次性穿刺成功率、一次性送鞘成功率、置管成功率,以及穿刺点疼痛、穿刺点渗血与渗液发生情况。结果观察组与对照组在性别、年龄、原发肿瘤来源、穿刺血管等方面的差异均无统计学意义(P均>0.05);所有患者均成功置管,观察组一次性穿刺成功率为95.7%(110/115),对照组为94.8%(109/115),两组间差异无统计学意义(P=0.757);观察组一次性送鞘成功率为100.0%(115/115),高于对照组(93.0%,107/115),两组间差异有统计学意义(P=0.007);观察组穿刺术中疼痛程度轻于对照组,置管后穿刺点渗血发生率也低于对照组,两组间差异均有统计学意义(P均<0.01);观察组患者置管后穿刺点均无渗液发生,对照组4例(3.5%)有少量渗液(P=0.122)。结论采用钝性扩皮送鞘行PICC置管可明显提高一次性送鞘成功率,减轻患者术中疼痛,降低置管后穿刺点渗血发生率,值得临床推广应用。

Objective To explore the clinical value of blunt separation method in reducing complications related to ultrasound-guided modified Seldinger technique(MST)peripherally inserted central catheter(PICC).Methods A total of 230 patients receiving PICC were randomly divided into observation group and control group(115 cases in each group)according to the random code generated by the random number table.The observation group was treated with blunt separation,while the control group was treated with scalpel.The success rates of one-time puncture,one-time catheterization and catheterization,the degree of intraoperative pain,and the incidence of errhysis and drug leakage at puncture site were compared between the 2 groups.Results There were no significant differences in gender,age,primary tumor source,or puncture blood vessel between the observation and control groups(all P>0.05).All patients were successfully catheterized.The success rate of one-time puncture was 95.7%(110/115)in the observation group and 94.8%(109/115)in the control group,with no significant difference(P=0.757).The successful rate of one-time catheterization was higher in the observation group(100.0%,115/115)than in the control group(93.0%,107/115),showing significant difference(P=0.007).The degree of pain during puncture and the incidence of errhysis were lower in the observation group than in the control group(both P<0.01).No exudation occurred in the observation group after catheterization,and a little exudation occurred in 4 cases(3.5%)of the control group(P=0.122).Conclusion The blunt separation method can improve the successful rate of one-time catheterization,relieve pain and reduce the incidence of errhysis at puncture site,making it worthy of clinical application.