耐高压注射型经外周静脉置入中心静脉导管与中心静脉导管在肝细胞癌肝切除术患者中的应用

Comparison of power peripherally inserted central catheter and central venous catheters in hepatocellular carcinoma patients undergoing hepatectomy

目的比较耐高压注射型经外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)与中心静脉导管(central venous catheters,CVC)在肝细胞癌患者行肝切除术后的应用效果。方法回顾性分析2019年1月至2020年10月在首都医科大学附属北京地坛医院行肝切除术的70例肝细胞癌患者的临床资料。根据放置静脉导管的方式将其分为耐高压注射型PICC组(36例)和CVC组(34例)。分析两组患者静脉穿刺次数、插管成功率、导管留置时间以及导管相关并发症发生情况。采用Logistic回归分析耐高压注射型PICC相关性感染的危险因素。结果耐高压注射型PICC组导管留置时间显著长于CVC组(中位数:14 d vs 7 d;z=-4.983,P<0.001),两组导管相关并发症发生率无显著差异[31%(11/36)vs 41%(14/34);χ^(2)=0.859,P=0.354]。耐高压注射型PICC组最常见的并发症为静脉炎(5例),而在B组中未观察到静脉炎的发生(χ^(2)=3.207,P=0.073)。耐高压注射型PICC组中无患者因无法耐受而要求拔除导管,CVC组中有6例(17.6%)患者因自觉不适而要求提前拔除CVC导管(χ^(2)=6.948,P=0.008),提示耐高压注射型PICC组耐受性显著好于CVC组。导管留置时间为耐高压注射型PICC相关性感染的独立危险因素(OR=1.393,95%CI:1.052~1.846,P=0.021)。结论对于肝切除术后的肝细胞癌患者的静脉输液治疗,耐高压注射型PICC优于CVC。

Objective To compare the effects of power peripherally inserted central catheter(PICC)and central venous catheters(CVC)on hepatocellular carcinoma patients undergoing hepatectomy.Methods The clinical data of 70 patients who underwent hepatectomy in Beijing Ditan Hospital,Capital Medical University from January 2019 to October 2020 were retrospectively analyzed.The patients were divided into power PICC group(36 cases)and CVC group(34 cases)according to the way the venous catheter was placed.The number of venipunctures,intubation success rate,catheter retention time and catheter-related complications were analyzed.Logistic regression was used to analyze the risk factors for infection in power PICC group.Results The median duration of venous catheterization in power PICC group was significantly longer than that in CVC group B(14 d vs 7 d;z=-4.983,P<0.001).There was no significant difference in the incidence of catheter-related complications between the two groups[31%(11/36)vs 41%(14/34);χ^(2)=0.859,P=0.354].Phlebitis is the most common complication in power PICC group(5 cases),but not observed in CVC group(χ^(2)=3.207,P=0.073).No patient in the power PICC group required catheter removal due to intolerance,while 6 patients(17.6%)in the CVC group required catheter removal in advance due to discomfort(χ^(2)=6.948,P=0.008),indicating that the tolerance of the power PICC group was significantly better than that of CVC group.The catheter retention time was the independent risk factor for catheter-related infections(OR=1.393,95%CI:1.052~1.846,P=0.021).Conclusions Power PICC is superior to CVC for intravenous infusion therapy in patients with hepatocellular carcinoma after liver resection.