不同置放途径中心静脉导管的临床效果研究

Clinical Application of the Central Venous Catheters via Different Accesses

目的对比两种经不同途径置放中心静脉导管的临床效果及并发症。方法选择需长期输液治疗的患者80例,分为A、B两组,每组各40例。A组应用双腔或单腔中心静脉导管(美国Arrow公司)经锁骨下静脉穿刺至上腔静脉置管,B组应用“经外周静脉置入中心静脉导管”(美国B-D公司PeripherallyInsertedCentralCatheter,简称PICC)经外周静脉置入中心静脉,观察2组置管成功率、流速及导管相关并发症30天。结果置管成功率相近(P=0.5562):PICC导管置管成功97.5%(39例);锁骨下静脉穿刺成功100%(40例)。导管堵塞率有明显差别(P=0.0231):PICC9例(22.5%),锁骨下静脉穿刺2例(5%)。锁骨下静脉置管流速明显快于PICC(P=0.0001)。其他导管相关并发症两组无明显差异(P=0.1521～0.5562)。气、血胸并发症:PICC未发生,锁骨下静脉穿刺1例(2.5%)。动脉损伤:PICC未发生,锁骨下静脉穿刺1例(2.5%)。导管易位:PICC2例(5%),锁骨下静脉穿刺1例(2.5%)。静脉炎:PICC2例(5%),锁骨下静脉穿刺未发生。导管感染:PICC未发生,锁骨下静脉穿刺2例(5%)。大多数PICC置管可由护士完成,而锁骨下静脉置管全部由医师操作。结论经锁骨下静脉置入的中心静脉导管流速大,是抢救危重患者的首选导管。PICC导管穿刺更安全、易推广;导管堵塞或感染后,能进行原地置换;是长期输?

Objectives To compare the characteristics of placement,clinical efficacy and complications of the central venous catheters via two different accesses.Methods Eighty patients needing long-term iv therapy were divided into Group A and Group B,with40cases in each group.In Group A,the single or double lumen central venous catheters(Arrow Company,USA)were placed into superior vena cava via subclavian vein;in Group B,the peripherally inserted central catheters or PICC(B-D Company,USA)were placed into superior vena cava via peripheral vein.Success rate of placement and catheter related complications were observed for30days.Results Success rate was similar (P=0.5562):97.5%(39placement)for PICC and100%(40placement)via subclavian venous access.Catheter occlusion rate was statistically different (P=0.0231):22.5%(9placement)for PICC and5%(2placement)via subclavian venous access.Other catheter related complications were not obviously different in the two groups (P=0.1521～0.5562).No pneumothorax or hemothorax complicated the PICCs while1(2.5%)pneumothorax occurred via subclavian venous access.Artery damage:only1(2.5%)occurred in subclavian venous access.Catheter translocation happened in2(5%)of the PICCs while1(2.5%)via subclavian access.Phlebitis was noticed in2(5%)of the PICCs but none via subclavian access.Catheter related infection:2(5%)via subclavian access,none by PICC.Most of the PICC were placed by nurses while all central catheters via subclavian access were placed by physicians.Conclusions Central venous catheters via subclavian access was of first choice to the critically illed patients who needed fast infusion for resuscitation.PICC was safer and easier to place,could be replaced in situ,which was the first type of central venous catheter to choose for long-term iv support or large dosage and long duration iv chemotherapy.Catheter related infection was not statistically different as the two venous access were concerned.