重症监护病房中心静脉置管术并发症发生情况分析  

Survey of Complication of Central Venous Catherization in ICU

作　　者：王静[1] 杜朝晖[1] 李建国[1] 周青[1] 胡波[1] 李璐[1] 刘畅[1] 甘泉[1] 罗云[1] 蔡书翰[1] 邓彬[1] 饶歆[1] 卢章洪[1] 

机构地区：[1]武汉大学中南医院重症医学科,湖北省武汉市430071

出　　处：《中国全科医学》2013年第15期1781-1783,共3页Chinese General Practice

摘　　要：目的分析重症监护病房(ICU)中心静脉置管术并发症发生情况。方法选取2011年6月—2012年6月我院接受中心静脉置管术的患者553例,根据科室不同分为ICU组265例,非ICU组288例。调查并发症发生情况,同时统计置管困难和非置管困难患者并发症发生情况。结果中心静脉置管术总并发症发生率为15.9%(88/553),其中机械性并发症发生率为11.6%(64/553),导管相关性感染发生率为4.3%(24/553)。ICU组患者并发症发生率为17.4%(46/265),非ICU组患者并发症发生率为14.6%(42/288),两组比较差异无统计学意义(χ2=0.79,P>0.05)。两组患者导管脱出和不畅发生率〔1.1%(3/265)与4.5%(13/288)〕、导管相关性感染发生率〔7.2%(19/265)与1.7%(5/288)〕,差异均有统计学意义(χ2值分别为5.17、9.80,P<0.05)。两组患者穿入动脉、气胸、导管异位发生率比较,差异均无统计学意义(χ2值分别为0.02、0.00和0.04,P>0.05)。置管困难42例,发生并发症21例(50.0%);非置管困难511例,发生并发症59例(11.5%),差异有统计学意义(χ2=46.38,P<0.05)。结论 ICU中心静脉置管术成功率高,并发症发生率低,但ICU患者需注意导管相关性感染,非ICU患者需注意加强导管护理,置管困难时建议应用超声引导穿刺来减少并发症。Objective To investigate the complication of central venous catherization （CVC） in ICU and to summarize the clinical experience and to propose prevention measures. Methods 553 patients underwent CVC from June 2011 to June 2012 in our hospital were divided into ICU group （265 cases） and non -ICU group （288 eases） . The complications were surveyed, and meanwhile the complications of difficult catherization and non - difficult catherization were analyzed. Results The general in- cidence of complications in CVC was 15.9% （ 88/553 ）, among which the incidence of mechanical complications was 11.6% （64/553） , the incidence of catheter -related infection was 4. 3% （24/553） . In ICU group, the incidence of complications was 17.4% （46/265）, and in non -ICU group, it was 14. 6% （42/288） . The difference between the two groups was not sta- tistically significant （X2 = 0.79, P 〉 0. 05 ） . Between the two groups, the incidences of catheter extrusion and obstruction 1.1% （ 3/265 ） vs. 4. 5 % （ 13/288 ） 3 and catheter - related infection [ 7. 2% （ 19/265 ） vs. 1.7% （ 5/288 ） ~ both showed sta- tistically significant differences （X2 = 5.17, 9. 80, P 〈 0. 05 ） . The incidences of artery penetration, pneumothorax and catheter misplacement between the two groups showed no statistically significant difference （X2 = O. 02, O. O0 and O. 04, P 〉 0. 05 ）. 42 eases had difficulties in cathefization and 21 （50. 0% ） of them had complications; 511 cases did not have difficulties in cather- ization and 59 （ 11.5% ） of them had complications. The difference between the two was statistically significant （X2 = 46. 38, P 〈 0. 05 ） . Conclusion ICU has high successful rate of eatherization and few complications. But the ICU patients should prevent infection and other departments should note the protection of catheter. Patients with difficulties in eatherization should be added ul- trasonic puncture to reduce complications.

关 键 词：导管插入术 中心静脉 并发症 重症监护病房 

分 类 号：R473.52[医药卫生—护理学]