超声引导下置入中等长度导管在口腔颌面肿瘤患者静脉治疗中的应用

Application of Midline Catheter Placed Under Ultrasound Guidance in Intravenous Therapy for Oral and Maxillofacial Tumor

目的探讨超声引导下置入中等长度导管的应用效果,为口腔颌面肿瘤患者选择合适的静脉留置导管方式。方法回顾调查2019年6月–2021年12月收治的143例口腔颌面肿瘤患者一般资料及静脉置管使用情况。2019年6月–2020年1月留置静脉留置针作为对照组,2020年6月–2021年12月超声引导下置中等长度导管作为观察组,分析比较两组静脉导管并发症发生情况(包括穿刺口渗血、静脉炎、堵管、渗出等)。基线不平衡时,则使用一般资料进行倾向得分匹配(propensity score matching,PSM),再进行并发症发生情况比较。结果对照组71例患者(留置215次留置针),观察组72例患者(留置72次中等长度导管),两组患者在年龄、性别、疾病诊断、抗凝药物使用等方面差异无统计学意义(P>0.05),观察组患者平均住院天数多于对照组患者(P<0.01)。观察组置管费用为1080元/套,日均费用约为(56.27±20.23)元;对照组平均每位患者留置(3.03±0.93)次,留置针费用为96元/次,日均费用约为(19.94±7.50)元,观察组日均费用与对照组差异有统计学意义(P<0.01)。对两组进行PSM,匹配前,观察组并发症发生率(8.3%,6/72)低于对照组(30.2%,65/215),差异有统计学意义(P<0.01);每组匹配后各纳入72次进行比较,观察组并发症发生率(8.3%,6/72)低于对照组(54.2%,39/72),差异有统计学意义(P<0.01)。结论超声引导下中等长度导管留置并发症发生率低,有利于减轻患者静脉反复穿刺的痛苦及临床护士的工作量,较适合在口腔颌面恶性肿瘤患者,尤其是外周静脉条件差的修复重建患者中推广使用。

Objective To examine the application effect of ultrasound-guided placement of midline catheter and to select the appropriate placement method of intravenous catheter for patients with oral and maxillofacial tumors.Methods We retrospectively analyzed the general data and venous catheter-related information of 143 oral and maxillofacial tumor patients who received treatment between June 2019 and December 2021.There were two patient groups,a control group of patients with inserted peripheral venous catheters(PVC)and an observation group of patients with midline catheters placed under ultrasound guidance.We made a comparative analysis of the incidence of catheterrelated complications,including bleeding at the insertion site,phlebitis,catheter blockage,extravasation,etc.,in the two groups.When the baseline data from the two groups were not balanced,we used propensity score matching(PSM)to match the general data before comparing the complication incidence between the two groups.Results There were 71 patients who underwent 215 times of PVC placement in the control group and 72 patients who underwent 72 times of midline catheter placement in the observation group.There was no significant difference between the patients in the two groups in terms of age,sex,diagnosis,or the use of anticoagulant medication(P>0.05).The observation group had longer average length-of-stay than the control group did(P<0.01).The cost of catheter placement in the observation group was 1080 yuan per set,with the average daily cost being about(56.27±20.23)yuan.Patients in the control group had PVC placement for an average of(3.03±0.93)times.The cost for PVC placement was 96 yuan per time and the average daily cost was about(19.94±7.50)yuan.There was significant difference in the average daily cost between the observation group and the control group(P<0.01).PSM was performed for the two groups.Before PSM,the incidence of catheter-related complications in the observation group(8.3%,6/72)was lower than that of the control group(30.2%,65/215)and the difference was statistically significant(P<0.01).After PSM,72 times of catheter placement from each group were included in comparative analysis.The incidence of catheter-related complications in the observation group(8.3%,6/72)was lower than that of the control group(54.2%,39/72)and the difference was statistically significant(P<0.01).Conclusion Patients have low incidence of catheter-related complications when they have midline catheter placed under ultrasound guidance,which helps reduce the pain of repeated venous insertion that patients incur and the workload of clinical nurses.The use of midline catheters is appropriate for and should be popularized among patients with oral and maxillofacial malignant tumors,especially patients who have poor peripheral venous conditions and those who are undergoing repair and reconstruction surgeries.