不同外留长度耐高压PICC在血液病患者中的效果观察

Observation on the effect of power PICC with two different external lengths in catheterization of patients with hematologic diseases

目的探讨2种不同外留长度耐高压PICC在血液病患者中的应用效果。方法对2020年8月至2021年8月在南方医科大学南方医院血液科行耐高压PICC置管的233例血液病患者进行回顾性分析,根据置管后导管外留长度分为0~1 cm组132例和2~4 cm组101例,比较2组患者置管后24 h、72 h、7 d、14 d的相关并发症发生率以及患者舒适度。结果置管后24 h和72 h,0~1 cm组患者穿刺点渗血发生率分别为14.39%(19/132)和9.85%(13/132),2~4 cm组患者穿刺点渗血发生率分别为30.69%(31/101)和32.67%(33/101),2组比较差异均有统计学意义(χ2=9.02、14.16,均P<0.05);0~1 cm组患者置管后7 d和14 d穿刺点红肿发生率为9.09%(12/132)和5.30%(7/132),2~4 cm组为40.59%(41/101)和22.77%(23/101),2组比较差异均有统计学意义(χ2=32.32、15.57,均P<0.05);0~1 cm组患者置管后7 d和14 d的导管轻度脱出率分别为18.18%(24/132)和21.97%(29/132),2~4 cm组分别为59.41%(60/101)和67.33%(68/101),2组比较差异均有统计学意义(χ2=42.18、55.86,均P<0.05);置管后14 d,0~1 cm组患者舒适度明显高于2~4 cm组,2组比较差异有统计学意义(Z=-4.4,P<0.05)。结论血液病患者留置耐高压PICC外留长度为0~1 cm时,可减少患者渗血风险,降低脱管率,并提高患者舒适度,值得临床应用推广。

Objective To investigate the effect of power PICC with two different external lengths in patients with hematologic diseases.Methods From August 2020 to August 2021,a retrospective analysis was conducted on 233 cases of hematologic diseases who received power PICC catheterization in Department of Hematology,the Nanfang Hospital of Southern Medical University,the patients were divided into 0-1 cm group(132 cases)and 2-4 cm group(101 cases)according to the external lengths after catheter insertion.The incidence of related complications and patient comfort at 24 hours,72 hours,7 days and 14 days after catheterization were compared between the two groups.Results At 24 hours and 72 hours after catheterization,the incidence of bleeding at puncture point in 0-1 cm group was 14.39%(19/132)and 9.85%(13/132),in 2-4 cm group was 30.69%(31/101)and 32.67%(33/101),the difference was statistically significant(χ2=9.02,14.16,both P<0.05).The rate of redness and swelling of punture point at 7 days after catheterization was 9.09%(12/132)and 40.59%(41/101)in the two groups,with statistical significance(χ2=32.32,P<0.05).The rates of slightly prolapse at 7 and 14 days after catheterization were 18.18%(24/132)and 18.94%(25/132)in 0-1 cm group,59.41%(60/101)and 67.33%(68/101)in 2-4 cm group,the difference between the two groups was statistically significant(χ2=42.18,55.86,both P<0.05).In the observation of comfort at 14 days after catheterization,the comfort score of patients in the 0-1 cm group was significantly higher than that in the 2-4 cm group,and the difference between the two groups was statistically significant(χ2=7.34,P<0.05).Conclusions Patients with hematologic diseases can reduce the risk of bleeding and slightly prolapse,and improve the comfort of patients when the external lengths is 0-1 cm of power PICC,which is worthy of clinical application and promotion.The catheterizer should adopt accurate in appropriate measurement method to determine the best lengths of the catheters.