脐静脉置管术在新生儿输液中的临床应用  

Clinical Application of Umbilical Vein Catheterization in Neonatal Transfusion

作　　者：夏晓芹[1] 卢庆晖[1] 阳红华[1] 张志刚[1] 唐上可 赖宝添 陈均龙[1] 

机构地区：[1]中山大学附属东华医院新生儿科,广东东莞523110

出　　处：《南昌大学学报（医学版）》2014年第6期47-49,共3页Journal of Nanchang University：Medical Sciences

摘　　要：目的探讨脐静脉置管技术在新生儿静脉营养支持中的临床应用价值。方法选择2011年6月至2014年1月入院至东华医院新生儿科,因不同疾病需要救治且需要静脉营养支持治疗的新生儿（早产儿54例,足月小样儿8例,足月儿合并重症不能进食者18例）80例,在出生〈24h内行脐静脉置管术,建立静脉输液通道,并对其临床应用效果进行分析。结果 80例患儿中77例置管成功,3例失败,置管成功率为96.3%。导管留置时间为7~21（7.5±2.2）d。其中4例使用1~3d后导管堵塞,1例拆管剪线时误剪断导管,且回缩,后采取手术取出;3例发生导管相关感染,行血培养检查均为阴性,感染率为3.75%。留置导管过程中未发生腹腔感染、心律失常、新生儿坏死性肠炎、肝实质损伤、肝坏死、血栓、空气栓塞及脐出血等并发症。结论脐静脉置管术是重症新生儿静脉营养支持的一项重要技术,操作相对容易掌握,不良反应少,较经外周中心静脉置管术（PICC）时间早、成功率较高,出生后早期即可以安全使用,尤其是在低体质量、极低体质量患儿的应用中有广泛的前景。Objective To explore the clinical value of umbilical venous catheterization technique in intravenous nutritional support in neonates.Methods Umbilical vein catheterization was performed within 24hours after birth to establish intravenous access in 80neonates who were admitted to the Department of Neonatology of the Affiliated Dungwah Hospital of Sun Yat-sen University from June 2011to January 2014for treatment and intravenous nutritional support（54premature infants,8small for gestational age infants and 18full-term infants with severe aphagosis）.The clinical efficacy was analyzed in all neonates.Results Among the 80neonates,umbilical venous catheterization was successful in 77（96.3%）and failed in 3.The average duration of indwelling catheters was（7.5±2.2）days（range,7to 21days）.Catheter blockage occurred in 4neonates 1-3days after catheterization.The catheter was sheared off and became retracted during demolition but was removed with surgery in 1neonate.Catheter-related infection occurred with negative blood culture result in 3neonates（3.75%）.No intra-abdominal infection,arrhythmia,necrotic enteritis,liver parenchymal cell injury,hepatonecrosis,thrombus,aeroembolism,omphalorrhagia and other complications were found during catheter indwelling.Conclusion Umbilical venous catheterization is important for intravenous nutritional support in neonates.The technique is relatively easy to grasp and results in fewer adverse reactions.It can be performed earlier and produce higher success rate than the perocutaneous-inserted central venous catheter（PICC）.Therefore,umbilical venous catheterization should be widely used for intravenous nutritional support,especially in low and extremely low birth weight infants.

关 键 词：脐静脉置管术 新生儿 静脉营养 

分 类 号：R722.1[医药卫生—儿科]