超声在外周静脉导管置入并发症及皮下水肿影响因素分析中的应用

Application of ultrasound in the analysis of factors affecting complications and subcutaneous edema after peripheral venous catheter placement

目的应用超声观察外周静脉导管(PIVC)置入患者并发症发生情况,分析皮下水肿发生的影响因素。方法选取我院重症医学科收治的171例导管规格为24 G的PIVC置入患者及100例导管规格为22 G的PIVC置入患者。应用超声测量留置针导管直径、血管距表皮距离、血管内导管长度、血管直径等,观察导管尖端是否贴壁、有无水肿及血栓发生,计算导管与静脉直径比值。依据是否发生皮下水肿,将导管规格为24 G的PIVC置入患者分为皮下水肿组和无水肿组,比较两组一般资料及超声参数的差异。采用二元Logistic回归分析皮下水肿的影响因素。比较置入不同规格导管的皮下水肿患者皮下水肿发生影响因素的差异。结果171例PIVC置入患者中,超声提示皮下水肿74例(43.3%)、静脉血栓26例(15.2%)、导管尖端贴壁98例(57.3%)。无水肿组(97例)与皮下水肿组(74例)刺激性药物使用史、谷丙转氨酶(ALT)、导管尖端是否贴壁、血管直径、导管与静脉直径比值、血管内导管长度比较,差异均有统计学意义(均P<0.05)。二元Logistic回归分析显示,导管尖端是否贴壁、导管与静脉直径比值≤33%均为皮下水肿的独立影响因素(均P<0.05)。本研究中导管规格为24 G和22 G的PIVC置入患者中发生皮下水肿分别为74例和46例,置入不同规格导管的皮下水肿患者导管与静脉直径比值比较,差异有统计学意义(P<0.05)。结论应用超声可客观评估留置针导管及其皮下组织,了解PIVC置入患者并发症发生情况,其中导管尖端是否贴壁、导管与静脉直径比值≤33%均为皮下水肿的独立影响因素。

Objective To observe the occurrence of complications in patients with peripheral venous catheter placement by ultrasound,and to analyze the influencing factors of subcutaneous edema.Methods One hundred and seventyone patients with catheter size 24 G peripheral venous placement and 100 patients with catheter size 22 G peripheral venous placement admitted to intensive care medicine ward of our hospital were selected.Ultrasound was applied to measure the indwelling needle catheter diameter,subcutaneous distance,intravascular catheter length,whether the tip was against the wall and vessel diameter,the occurrence of edema and thrombosis were observed,and the catheter venous diameter ratio was calculated.Patients with peripheral venous catheter placement with catheter size 24 G were divided into subcutaneous edema group and non-edema group according to whether subcutaneous edema occurred,and the differences of clinical data and ultrasound parameters between the two groups were compared.Binary Logistic regression was used to analyze the factors influencing the occurrence of subcutaneous edema.The influencing factors of subcutaneous edema were compared in patients with subcutaneous edema implanted with different catheters.Results Among 171 patients with peripheral venous catheter placement,subcutaneous edema was observed by ultrasound in 74 cases(43.3%),venous thrombosis in 26 cases(15.2%),and the tip was against the wall in 98 cases(57.3%).There were statistically significant differences between the non-edema group(97 cases)and subcutaneous edema group(74 cases)in the history of stimulant drug use,alanine aminotransferase(ALT),whether the tip was against the wall,vessel diameter,catheter-venous diameter ratio,and length of intravascular catheter(all P<0.05).Binary Logistic regression analysis showed that whether the tip was against the wall and catheter-venous diameter ratio≤33%were independent risk factors for subcutaneous edema(both P<0.05).74 patients with 24 G peripheral venous catheter implantation developed subcutaneous edema,and 46 patients with 22 G peripheral venous catheter implantation developed subcutaneous edema.The catheter-vein diameter ratio of subcutaneous edema patients with different sizes of catheter was compared,and the difference was statistically significant(P<0.05).Conclusion Ultrasound can objectively evaluate the indwelling catheter and its subcutaneous tissue,and understand the occurrence of complications in patients with peripheral venous catheter implantation,whether the catheter tip is against the wall and the catheter-vein diameter ratio≤33%are independent influencing factors of subcutaneous edema.