西安市儿童医院儿科重症监护病房中心静脉置管相关并发症及危险因素分析

Complications of central venous catheterization and risk factors in Pediatric Intensive Care Unit of Xi'an Children's Hospital

目的分析西安市儿童医院儿科重症监护病房(PICU)中心静脉导管(CVC)置管相关并发症的发生率和影响因素。方法回顾性分析2020年6月至2021年2月西安市儿童医院PICU住院的行CVC置管患儿310例的临床资料,统计分析CVC置管相关并发症发生情况及危险因素。结果310例患儿共置入334个CVC,其中102例(30.54%)出现CVC置管相关并发症。与CVC置入相关的并发症为导管感染(13.17%)、导管错位(8.38%)、穿刺部位渗出(4.79%)、导管闭塞(2.99%)、意外移除(0.60%)及中心静脉血栓形成(0.60%)。82例(24.55%)CVC因并发症拔管。CVC置管入路为股静脉、颈内静脉、锁骨下静脉等三组中心静脉血栓形成发生率差异有统计学意义(χ^(2)=7.06,P=0.029);置管时间越长,总并发症发生率越高,如导管相关性感染(χ^(2)=7.17,P=0.028)、穿刺点渗液及阻塞(χ^(2)=8.59,P=0.014)、中心静脉血栓形成(χ^(2)=6.78,P=0.034)。经回归分析显示,患儿的缝线脱落、置入部位出血是导管相关并发症的主要危险因素,差异有统计学意义(缝线脱落OR=4.85,P=0.001;置管部位出血OR=1.83,P=0.008)。结论西安市儿童医院PICU留置CVC最常见的并发症是导管相关感染、导管错位、穿刺部位渗液。导管留置期间并发症的主要危险因素有缝线脱落、置入部位出血。

Objective To analyze the incidence of complications of central venous catheterization and risk factors in the Pediatric Intensive Care Unit of Xi'an Children's Hospital.Methods The clinical data of 310 children who underwent central venous catheterization in the Pediatric Intensive Care Unit of Xi'an Children's Hospital from June 2020 to February 2021 were retrospectively analyzed.The incidence of complications of central venous catheterization and risk factors were analyzed.Results A total of 334 central venous catheters were used in 310 chidren.Among the 310 children who underwent central venous catheterization,102 children(30.54%)had complications related to central venous catheterization.The complications related to central venous catheterization included catheter infection(13.17%),catheter malposition(8.38%),exudation at the puncture site(4.79%),catheter occlusion(2.99%),accidental removal(0.60%),and central venous thrombosis(0.60%).Central venous catheters were removed in 82 children(24.55%)because of complications.There was a significant difference in the incidence of central venous thrombosis among three surgical approaches:femoral vein,internal jugular vein,and subclavian vein(χ^(2)=7.06,P=0.029).Longer time for catheterization resulted in a higher incidence of complications,including catheter-related infection(χ^(2)=7.17,P=0.028),puncture point exudation and obstruction(χ^(2)=8.59,P=0.014),central venous thrombosis(χ^(2)=6.78,P=0.034).Regression analysis showed that suture shedding and bleeding at the insertion sites were the main risk factors for catheter-related complications(suture shedding OR=4.85,P=0.001;bleeding at the insertion sites OR=1.83,P=0.008).Conclusion The most common complications of central venous catheterization in the Pediatric Intensive Care Unit of Xi'an Children's Hospital include catheter-related infection,catheter malposition,and puncture site exudation.Risk factors for complications during catheter retention include suture shedding and bleeding at the insertion sites.