恶性肿瘤患者三种隧道式PICC置管效果观察

Effect observation of three tunneled PICC catheterization methods in patients with malignant tumor

目的比较恶性肿瘤患者三种隧道式PICC置管效果。方法将644例恶性肿瘤患者随机分成常规组(n=208),采用常规方法建立隧道;试验组A(n=216),采用常规方法+0.5%利多卡因皮下组织分离后建立隧道;试验组B(n=220),采用常规方法+0.9%氯化钠注射液皮下组织分离后建立隧道。结果三组术中总出血量、置管时疼痛评分、置管后24 h穿刺点渗血发生率、导管自隧道引出一次成功率比较,差异有统计学意义(均P<0.05)。上述指标两两比较,试验组A、B分别与常规组比较,差异有统计学意义(P<0.05,P<0.0167);试验组A与试验组B比较差异无统计学意义(均P>0.05)。常规组3例(1.44%)发生神经损伤,5例(2.40%)发生动脉误伤;试验组A 2例(0.93%)发生局麻药中毒反应。结论在隧道式PICC置管中,采用0.9%氯化钠注射液对皮下组织分离建立隧道方法能减少患者出血,减轻疼痛,提高导管引出成功率,且安全性好。

Objective To compare the effect of three tunneled PICC catheterization methods in malignant tumor patients.Methods A total of 644 malignant tumor patients with tunneled PICC catheterization were randomized into a conventional group(n=208),whose tunnel was established by using conventional method;an experimental group A(n=216),whose tunnel was established ad-ditionally by using 0.5%lidocaine to separate the subcutaneous tissue of tunnel site;and an experimental group B(n=220),whose tunnel was established by using normal saline to separate the subcutaneous tissue of tunnel site on the basis of the conven-tional method.Results There were significant differences among the three groups in total intraoperative bleeding weight,pain score during catheterization,incidence of bleeding at the puncture point 24 hours after catheterization,and once success rate of catheter extraction from the tunnel(all P<0.05).When the above indicators were compared further between any two groups of the three,there were significant differences between the conventional group and the experimental group A and B(P<0.05,P<0.0167),while there were no significant differences between the experimental group A and the experimental group B(all P>0.05).In the conventional group,3 patients(1.44%)suffered from nerve injury,and 5 patients(2.40%)experienced accidental artery injury.In the experimental group A,2 patients(0.93%)encountered local anesthetic drug induced poisoning reaction.Conclusion In tun-neled PICC catheterization,the establishment of tunnel by using normal saline to separate subcutaneous tissue can reduce bleeding,alleviate pain,improve the success rate of catheter extraction,and has higher safety.