不同长度外周静脉导管在减重手术患者围手术期的应用效果评价

Study on the application of different-length peripheral intravenous catheters in patients undergoing metabolic and bariatric surgery:a randomized clinical trial

目的比较不同长度外周静脉导管在减重手术患者围手术期的临床应用效果,探究减重手术等肥胖患者的适宜静脉通路。方法采用定点连续抽样法,选取2022年8月—12月在浙江某三级甲等医院进行减重手术的住院患者作为研究对象。采用分层区组随机法分为试验组1(迷你中长导管)、试验组2(中长导管)和对照组(短外周静脉导管)。比较3组导管相关并发症发生率、因并发症拔管率、导管留置时间和发生首次导管相关并发症的时间。结果共纳入186例患者,每组62例。试验组1、试验组2和对照组的导管相关并发症发生率为25.81%、8.06%、58.06%,因并发症拔管率为19.35%、4.84%、41.94%,导管留置时间为7.00(6.00,7.00)、7.00(6.00,7.00)、6.00(3.00,6.25)d,3组比较,差异具有统计学意义(P<0.05)。两两比较结果显示,试验组1和对照组、试组验2和对照组、试验组1和试验组2,导管相关并发症发生率、因并发症拔管率差异均具有统计学意义(P<0.017);在导管留置时间上,试验组1和试验组2均长于对照组,差异具有统计学意义(P<0.017),试验组1和试验组2比较,差异无统计学意义(P>0.017)。结论迷你中长导管和中长导管并发症发生率低于短外周静脉导管,留置时间与减重手术围手术期时间一致,适宜在减重手术等肥胖患者中应用。

Objective To investigate the appropriate venous access for obese patients undergoing metabolic and bariatric surgery by comparing the clinical outcomes of different lengths of peripheral intravenous catheters.Methods Inpatients who underwent bariatric surgery in a tertiary hospital in Zhejiang from August 2022 to December 2022 were selected as the study population using a fixed-point continuous convenience sampling method.A stratified block randomisation method was used to divide the group into an experimental group 1(mini-midline catheters),an experimental group 2(midline catheters)and a control group(short peripheral intravenous catheters,Short PIVCs).The incidence of catheter-related complications,the rate of extubation due to complications,the duration of catheter retention,the time to first catheter-related complication were compared in the 3 groups.Results A total of 186 patients were included,with 62 patients in each group.The overall incidence of catheter-related complications in experimental group 1,experimental group 2,and control group were 25.81%,8.06%,and 58.06%.The extubation rates due to complications were 19.35%,4.84%,and 41.94%,and the duration of catheter retention was 7.00(6.00,7.00)d,7.00(6.00,7.00)d,6.00(3.00,6.25)d.The differences were statistically different(P<0.05)when comparing the 3 groups.Among them,the differences in the overall incidence of catheter-related complications and the rate of extubation due to complications were statistically significant when comparing experimental group 1 with the control group,experimental group 2 with the control group,and experimental group 1 with experimental group 2(P<0.017);the duration of catheter retention in both experimental group 1 and experimental group 2 were higher than it in the control group,and the differences were statistically different(P<0.017).Conclusion The complication rate of mini-midline catheters and midline catheters is lower than that of short ones,and the indwelling time is consistent with the perioperative period of metabolic and bariatric surgery,which is suitable for use in patients undergoing metabolic and bariatric surgery.