B 超引导下插管鞘内鞘扩皮预防 PICC 置管后穿刺点渗血的研究

Effect of skin expansion by B- mode ultrasound with modified Seldinger technique on preventing puncture site bleeding after the catheterization in breast cancer patients

目的：探讨经 B 超引导下插管鞘内鞘扩皮对预防 PICC 后穿刺点渗血的作用。方法选取2015年1-7月于天津医科大学肿瘤医院乳腺内科就诊且需行 PICC 的乳腺癌患者100例，按随机数字表法分为观察组和对照组各50例。2组均采用 B 超引导下结合塞丁格穿刺技术进行 PICC，对照组采用解剖刀扩皮，观察组采用插管鞘内鞘扩皮，比较2组患者置管后1周内渗血总量及平均换药次数。结果观察组置管后1周内局部渗血总量、平均换药次数分别为（0.491±0.241）ml、（1.060±0.239）次，对照组分别为（2.903±1.046）ml、（3.500±0.646）次，差异有统计学意义（t=15.889、25.049，均 P＜0.01）。结论采用插管鞘内鞘扩皮可减轻 PICC 后穿刺点渗血，该技术值得在临床推广使用。

Objective To explore the effect of skin expansion by B- mode ultrasound with modified Seldinger technique (MST) on preventing puncture site bleeding after the catheterization in breast cancer patients. Methods One hundred chemotherapy breast cancer patients who need to be catheterized PICC were recruited to participate in a randomised controlled trial in Tianjin Medical University Cancer Institute& Hospital, China. Fifty were assigned to the experimental group (using Intra- thecal intubation sheath), and 50 were assigned to the control group (expansion skin by scalpel). The two groups used modified Seldinger technique (MST) during the procedure of ultrasound guided PICC insertion, Patients errhysis and average frequency of dressing- change were collected for 1 week since catheterization to compare the effects of the two methods. Results Patients′errhysis and average frequency of dressing- change were (0.491±0.241) ml, (1.060±0.239) times in the experimental group, significantly lower than (2.903±1.046) ml, (3.500±0.646) times of the control group (t=15.889, 25.049, P < 0.01). Conclusions This study showed a lower incidence errhysis of skin expansion by intra- thecal intubation sheath used for PICC insertion. This technique deserved clinic application in PICC.