超声引导下改良Seldinger技术与盲穿法行PICC在肿瘤患者中的对比研究  

Comparative Study of Ultrasound-guided Modified Seldinger Technique and Blind Insertion for Peripherally Inserted Central Catheters(PICC) in Cancer Patients

作　　者：陈雅玫[1] 石新华[1] 张煜[1] 

机构地区：[1]北京大学第三医院肿瘤科,北京100191

出　　处：《中国微创外科杂志》2013年第12期1131-1133,1144,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的 探讨超声引导下改良Seldinger技术行外周静脉置入中心静脉导管（peripheral inserted central venous catheter,PICC）的价值.方法 2011年1月-2013年3月对213例肿瘤患者采用超声引导下改良Seldinger技术行PICC（超声引导组）,与采用盲穿法的230例肿瘤患者（盲穿组）进行对比,比较2组PICC穿刺置管成功率及相关并发症.结果超声引导组一次性穿刺成功率95.3%（203/213）,显著高于盲穿组78.3%（180/230）（χ2=27.436,P=0.000）,一次性置管成功率98.1%（209/213）,显著高于盲穿组78.3%（180/230）（χ2=40.755,P=0.000）.超声引导组血栓性静脉炎发生率为0 5%（1/212）,显著低于盲穿组4.5%（9/202）（χ2=5.377,P=0.020）;机械性静脉炎发生率0.9%（2/212）,显著低于盲穿组7.9%（16/202）（χ^2=12.109,P=0.001）.超声引导组无一例发生导管相关性感染,盲穿组1例,2组比较无统计学差异（Fisher＇s检验,P=0.488）.结论超声引导下改良Seldinger技术对肿瘤患者行PICC比盲穿法可以显著提高穿刺置管成功率,并发症少,安全有效.Objective To investigate the clinical value of ultrasound-guided modified Seldinger technique for PICC in cancer patients. Methods From January 2011 to March 2013, ultrasound-guided modified Seldinger technique for PICC was applied in 213 cases of cancer patients （ ultrasound-guided group） , while blind insertion was applied in 230 cases of cancer patients （blind insertion group）. The puncture and catheterization success rate and related complications were compared between the two groups. Results The puncture success rate of ultrasound-guided group was 95.3% （203/213）, significantly higher than that of blind insertion group （78.3% , 180/230; X2 = 27. 436, P = 0. 000 ） ; catheterization success rate of ultrasound-guided group was 98. 1% （ 209/213 ）, significantly higher than that of blind insertion group （78. 3%, 180/230; X^2 = 40. 755, P = 0. 000）; thrombophlebitis rate of ultrasound-guided group was 0.5% （1/212） , significantly lower than that of blind insertion group （g. 5% ,9/202 ; X^2 = 5. 377 ,P = 0. 020） ; mechanical phlebitis rate of ultrasound-guided group was 0. 9% （2/212） , significantly lower than that of blind insertion group （7.9% ,16/202; X^2 = 12. 109, P = 0. 001 ）. No patient in ultrasound-guided group developed catheter-related infection while only one patient （0.5% , 1/212） in blind insertion group developed catheter-related infection,and no significant difference was found between the two groups （ Fisher＇ s Exact Test,P = 0. 488 ）. Conclusions The application of ultrasound-guided modified Seldinger technique for PICC in cancer patients significantly increases puncture and catheterization success rate, and causes few complications. The procedure is safe and effective for cancer patients.

关 键 词：改良SELDINGER技术 外周静脉置入中心静脉导管 超声引导 

分 类 号：R730.5[医药卫生—肿瘤]