超声引导下改良塞丁格技术行PICC置管两种扩皮角度的比较  

Comparison of two skin incision methods for placement of peripherally inserted central venous catheters using ultrasound guidance and modified Seldinger technique

作　　者：徐寅[1] 李蓉梅[2] 傅荣[2] 袁玲[2] 周峥[1] 

机构地区：[1]南京大学医学院附属鼓楼医院普外科,江苏南京210008 [2]南京大学医学院附属鼓楼医院内科,江苏南京210008

出　　处：《护理学杂志》2014年第1期40-41,共2页

基　　金：国家临床重点专科项目

摘　　要：目的比较超声引导下改良塞丁格技术行PICC置管两种扩皮角度的临床效果。方法将100例PICC置管患者随机分为两组各50例。成功置入导丝后,纵切组90°扩皮即刀刃向上与皮肤垂直扩皮,横切组180°扩皮即刀刃与皮肤平行扩皮。结果纵切组扩皮后即刻、置管后24h及7d出血量显著少于横切组,扩皮后疼痛程度显著轻于横切组(均P<0.01);纵切组一次送鞘成功率(100%)高于横切组(90.0%)。结论超声引导下改良塞丁格技术行PICC置管扩皮时采用纵切法可有效减少扩皮后出血,减轻患者疼痛,提高一次送鞘成功率。Objective To compare the effect of two skin incision methods for placement of peripherally inserted central venous catheters （PICC） using ultrasound guidance and modified Seldinger technique. Methods One hundred patients were randomized into two groups of 50. After successful guide wire insertion, a 3 mm incision was made on the skin at the base of the wire to facilitate entry of the dilator and then the central venous catheter. The incision was made using a No. 11 scalpel blade held with the cutting edge upward （longitudinal incision group） or parallel to the skin （transverse incision group）. Results The average bleeding amount immediately after successful insertion of PICC, 24 h and 7 days after insertion, and the severity of pain at access site in the longitudinal incision group were significantly less/milder than those in the transverse incision group （P〈0.01 for all）. The success rate of PICC placement was 100% in the longitudinal incision group and 90.0% in the transverse incision group, with no statistical difference （P〉0.05）. Conclusion A longitudinal incision for placement of PICC using ultrasound guidance and modified Seldinger technique, could reduce bleeding, alleviate pain, and promote success rate.

关 键 词：PICC 超声引导 塞丁格技术 扩皮 纵切 横切 

分 类 号：R472[医药卫生—护理学]