超声导引结合改良塞丁格技术行上臂PICC置入与盲穿置管的比较  

Comparison of efficacies of upper arm placement of peripherally inserted central venous catheters:using ultrasound guidance and modified Seldinger technique versus traditional method

作　　者：张晓菊[1] 陆箴琦[1] 戴宏琴[1] 路虹 沈艳芬[3,4] 范育英 袁忠[6] 

机构地区：[1]复旦大学附属肿瘤医院护理部,上海市200032 [2]中国医学科学院附属肿瘤医院妇科 [3]北京肿瘤医院 [4]北京市肿瘤防治研究所静脉通路中心 [5]中山大学肿瘤防治中心鼻咽科 [6]湖南省肿瘤医院内科

出　　处：《中华护理杂志》2011年第1期42-45,共4页Chinese Journal of Nursing

摘　　要：目的比较超声导引结合改良塞丁格技术进行上臂PICC置入与传统PICC置入的效果差异。方法采用多中心随机对照研究,共5家三级甲等肿瘤专科医院的150例患者参与本次研究,按照随机数字表法分为观察组和对照组,各75例。分别在置管过程中、置管第2天、中间回访和置管第7天,比较两组患者置管成功率、穿刺点渗血、机械性静脉炎发生情况及置管手臂舒适度等指标的差别。结果两组患者置管成功率均为100%,出血量、导管末端位置的差异无统计学意义(P>0.05);置管第2天及中间回访时,两组患者穿刺点渗血、穿刺点情况、手指肿胀的差异亦无统计学意义(P>0.05),但观察组机械性静脉炎发生情况好于对照组,差异有统计学意义(P<0.05);第7天回访时,观察组穿刺点渗血、手指肿胀、机械性静脉炎发生情况、置管手臂的舒适度均优于对照组,差异有统计学意义(P<0.05或P<0.01)。结论超声导引结合改良塞丁格技术进行上臂PICC置入能明显改善穿刺点渗血、手指肿胀、机械性静脉炎和置管手臂舒适度。Objective To compare the efficacies of upper arm placement of peripherally inserted central venous catheters using ultrasound guidance and modified Seldinger technique with traditional method. Methods A multicenter,randomized,and blind controlled trial was conducted in 150 patients from five cancer hospitals. The patients were randomly assigned to control group and experiment group. The success rate of PICC placement,the complications of insertion sites,mechanical phlebitis,and the comfort of insertion arms were recorded and compared immediately and on the second and seventh days with PICC-inser- tion,respectively. Results The successful rate of PICC placement was 100% in both groups. No significant differences were found on the incidence of hemorrhage of insertion sites and the position of PICC tips during the process of PICC-insertion be- tween the two groups（P〉0.05）. There were no significant differences on the incidence of hemorrhage of insertion sites and fin- ger swelling on the second day with PICC （/）〉0.05）. But the incidence of mechanical phlebitis in the experiment group was significantly lower than that of control group （P〈0.05）. Significant differences were found on the incidence of hemorrhage of insertion sites,finger swelling,mechanical phlebitis and the degree of comfort between two groups on the seventh day with PICC（P〈0.05 or 0.01）. Conclusion The method of PICC insertion utilizing ultrasound guidance and modified Seldinger tech- nique can reduce the incidence of hemorrhage of insertion sites ,finger swelling and mechanical phlebitis while improve the comfort of the inserted arms in patients.

关 键 词：导管插入术 外周 超声检查 静脉炎 

分 类 号：R472[医药卫生—护理学]