超声引导改良外周静脉导入中心静脉置管术临床应用经验  

Clinical Experience of Color Doppler Ultrasound-Guided Improved Peripherally Inserted Central Catheter

作　　者：李东海[1] 程芳[1] 朱超逸 丁岩[2] 华克勤[2] 钱海林[1] 

机构地区：[1]江苏省淮安市妇幼保健院超声科,江苏淮安223002 [2]复旦大学附属妇产科医院妇科,上海200011

出　　处：《现代生物医学进展》2015年第2期298-301,共4页Progress in Modern Biomedicine

基　　金：上海市科学技术委员会西医类引导项目(124119a5501)

摘　　要：目的:探讨超声引导下改良的外周静脉导入中心静脉置管术(Peripherally Inserted Central Catheter,PICC)的临床应用。方法:对42例有恶性肿瘤病史需行PICC置管、浅静脉直视下不明显或触摸不到、不适合盲穿患者42例进行超声引导下改良的PICC术。改良方法包括穿刺支架超声引导以及用一次性使用麻醉用针替代Seldinger包内的穿刺针进行,并与23例标准PICC法对比分析穿刺成功率及穿刺并发症发生率。结果:两种方法穿刺成功率均为100%,其中改良PICC患者41例穿刺一次成功,一次成功率为97.6%;标准PICC患者21例穿刺一次成功,一次成功率为91.3%。两种方法一次成功率差异无统计学意义(P>0.05)。42例改良患者中发生2例并发症,包括局部水肿1例及导管异位1例;23例标准PICC患者中发生6例并发症,包括局部水肿2例,导管异位1例,静脉炎1例及局部感染2例。两种方法并发症发生率差异有统计学意义(P=0.019)。结论:超声引导下改良的PICC术一次成功率高,并发症少,值得临床推广。Objective： The aim of this study was to investigate the clinical value and the advantages of the improved peripherally inserted central catheter （PICC） guided by color Doppler ultrasound. Methods： Forty-two patients with malignant tumor history were included in this study. They all needed PICC and were not suitable for blind puncture because the superficial veins were not palpated. The improved PICC guided by color Doppler ultrasound were used. The improvements included the use of puncture frame on the probe and the substitution of one-off anesthesia needles for puncture needles in Seldinger package. The puncture success rate and the complication rate were analyzed and compared with 23 patients using standard PICC. Results： Both the improved PICC and the standard PICC had a 100 % puncture success rate. One-time success rate of the improved PICC and standard PICC were 97.6 % （41/42） and 91.3 % （21/23）. And the difference was not statistically significant （P〉0.05）. Two patients with improved PICC had complications, including one case of local edema and one case of catheter heterotopia; six patients with standard PICC had complications, including two cases of local edema, one case of catheter heterotopia, one case of phlebitis and two cases of local infection. And the difference of the complication rate was statistically significant （P=0.019）. Conclusions： The improved PICC guided by color Doppler ultrasound had higher success rate and lower complication rate compared with standard PICC and it was worthy of clinical promotion.

关 键 词：外周静脉导入中心静脉置管术 超声引导 穿刺支架 

分 类 号：R730.5[医药卫生—肿瘤] R445.1[医药卫生—临床医学]