高颅压患者经中等长度静脉导管输注甘露醇注射液导管相关并发症的影响因素

Influencing factors of catheter-related complications in patients with intracranial hypertension treated with mannitol injection via midline catheter

目的探讨高颅压患者经中等长度静脉导管(MC)输注体积分数20%甘露醇注射液导管相关并发症的发生情况及影响因素。方法回顾性分析郑州大学第一附属医院神经重症监护病房2019年11月至2020年8月经MC输注体积分数20%甘露醇注射液的909例高颅压患者的临床资料,按照输液期间是否发生导管相关并发症将患者分为并发症组与无并发症组,采用独立样本t检验或χ^(2)检验对导管相关并发症相关因素进行单因素分析,二分类logistic回归分析对导管相关并发症相关因素进行多因素分析。结果909例患者中,24例发生导管相关并发症,导管相关并发症发生率为2.64%;其中血凝性导管堵塞9例(0.90%),渗出6例(0.66%),静脉炎6例(0.66%,均为1级静脉炎),导管相关性血栓形成3例(0.33%)。单因素分析显示,经MC输注时间、MC尖端位置、MC留置时间与导管相关并发症的发生有关(P<0.05);年龄、性别、穿刺静脉、MC型号与导管相关并发症的发生无关(P>0.05)。logistic回归分析结果显示,MC尖端位置位于锁骨下静脉开口处是导管相关并发症的保护因素(OR=0.161,P<0.05),MC留置时间>28 d及经MC输注时间>14 d是导管相关并发症的危险因素(OR=25.257、14.000,P<0.05)。结论高颅压患者置入MC输注体积分数20%甘露醇注射液时应将导管尖端位置达到锁骨下静脉开口处、导管留置时间控制在28 d内、输注时间应不超过14 d,以降低导管相关并发症的发生率。

Objective To investigate the incidence of catheter-related complications of 20%mannitol injection through midline catheter(MC)in patients with intracranial hypertension and its influencing factors.Methods The clinical data of 909 patients with intracranial hypertension treated with infusion of 20%mannitol injection via MC in the Neurological Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University from November 2019 to August 2020 were analyzed retrospectively.The patients were divided into the group with complication and the group without complication according to whether cathe-ter-related complications occurred during infusion.The independent sample t-test orχ^(2) test were used for univariate analysis to analyze influencing factors of catheter-related complications,and binary logistic regression analysis was used for multivariate analysis to analyze influencing factors of catheter-related complications.Results Among the 909 patients,24 patients had catheter-related complications,the incidence of catheter-related complications was 2.64%;among them,there were 9 cases(0.90%)of hemagglutinating catheter obstruction,6 cases(0.66%)of exudation,6 cases(0.66%)of phlebitis(grade 1 phlebitis),and 3 cases(0.33%)of catheter-related thrombosis.Univariate analysis showed that the time of MC infusion,position of MC tip and time of MC indwelling were related to the occurrence of catheter-related complications(P<0.05);the age,sex,puncture vein and MC model were not related to the occurrence of catheter-related complications(P>0.05).Binary logistic regression analysis showed that the position of MC tip at the opening of the subclavian vein was the protective factor for catheter-related complications(OR=0.161,P<0.05).The time of MC indwelling more than 28 days and the time of infusion viaMC more than 14 days were the risk factors of catheter-related complications(OR=25.257,14.000;P<0.05).Conclusion When patients with intracranial hypertension are implanted with MC for infusion of 20%mannitol injection,the MC tip should reach the opening of subclavian vein,the MC retention time should be within 28 days,and the infusion time of 20%mannitol injection should not exceed 14 days,so as to reduce the incidence of catheter-related complications.