经外周中心静脉导管和锁骨下静脉导管在血液病治疗中的对比研究

Comparison of Peripherally Inserted Central Catheters and Subclavian Venous Catheters in Therapy of Hematological Diseases

目的 经外周中心静脉导管(peripherally inserted central catheters,PICC)和锁骨下静脉导管在血液病治疗中的对比研究,为今后的工作提供指导。方法 比较PICC导管和锁骨下静脉置管的成功率、操作时间、留置时间、液体流速、并发症的发生率,以及拔管后导管内壁的光滑度。结果 PICC组静脉穿刺一针见血率、穿刺成功率显著高于锁骨下静脉穿刺(P<0.01),但穿刺成功后把导管置入上腔静脉的成功率以及总成功率和锁骨下静脉置管组无显著差别(P>0.05);PICC组穿刺置管平均操作时间(11min)明显少于锁骨下静脉置管组(35min);两组并发症总发生率分别为23.5％和38.3％,无显著差异(P>0.05);两组导管平均留置时间分别为113d和42d,差异显著(P<0.05);锁骨下静脉导管液体流速明显优于PICC组;置管时间较长时,PICC导管内壁光滑,而锁骨下静脉导管内壁沉积物多。结论 PICC导管插管快捷方便、安全,无严重并发症发生,保留时间长,生物相容性佳,在体内保留较长时间后导管内壁无沉积物,不会发生微血栓。但鉴于其临床应用的局限性,在血液病的治疗中,可根据患者的外周血管情况、具体治疗要求,与锁骨下静脉导管互补使用。

Objective To determine the advantages and shortcomings of peripherally inserted central catheters (PICC) and subclavian venous catheters (SVC) in the therapy of hematological diseases. Methods Of 81 clinical patients 34, received PICC and 47 received SVC. Results The rates of successful puncturing and successful penetration were higher in PICC group than in SVC group and the difference was significant (P<0.01). But the difference was not significant in the placement of the catheters into the upper vena cava and the overall successful rates after penetration between the two groups (P>0.05). Mean time needed in catheterization was 11 minutes for PICC and 35 minutes for SVC. There was no significant difference in the incidence of complications between PICC group (23.5%) and SVC group (38.3%) (P>0.05). The median placement time was 113 days for PICC, and 42 days for SVC, which was much shorter than the former. The liquid velocity was much fast in SVC group. The sediments on the inner wall of SVC would increased significantly with the elongation of placement while they remained sleek for PICC. Conclusion Both PICC and SVC had their own advantages in the therapy of hematological diseases. The benefits of PICC included rapidness, safety, no complications and long time placement. The 3-position valve PICC produced by C. R. Bard Inc. had good bio-compatibility and tends to assure long time placement without any sediments and thrombosis. As both catheters had their limitations and advantages, we suggest selecting the catheters according to the condition of patients peripheral veins and the requirements of specific therapy.