肺癌合并上腔静脉梗阻患者股静脉留置PICC导管的研究  

The feasibility of ultrasound-guided PICC insertion by the middle-thigh femoral vein in lung cancer patients with superior vena cava obstruction

作　　者：张京慧[1] 李雪兵[2] 贺连香[2] 曹立明[3] 张彩兰[3] 唐四元[1] 

机构地区：[1]中南大学护理学院,长沙市410008 [2]中南大学湘雅医院护理部 [3]中南大学湘雅医院呼吸内科

出　　处：《中华护理杂志》2015年第6期692-696,共5页Chinese Journal of Nursing

基　　金：湖南省科技厅科技支撑计划课题(2014SK3093);2013年中南大学新技术立项项目

摘　　要：目的探讨成人肺癌并上腔静脉梗阻患者超声引导下经大腿中部股静脉留置PICC导管的临床置管效果及并发症发生率,为此类患者优选血管通路提供依据。方法选取置管信息记录完善、住院和出院间歇期均在医院维护且能全程跟踪随访到的258例肺癌化疗患者进行回顾性分析,以接受"超声引导下经大腿中部股静脉PICC置管"的肺癌并上腔静脉梗阻患者为实验组(n=58),以接受"超声引导下经上臂贵要静脉PICC置管"的肺癌无上腔静脉梗阻患者为对照组(n=200),比较两组的置管效果及导管留置期间的并发症发生率。结果实验组的出血量评分(2.55±0.71)低于对照组(3.04±0.74),实验组的一次性置管成功率(98.28%)大于对照组(80.00%),差异均有统计学意义(均P<0.001);实验组和对照组的一次性穿刺成功率(96.55%,96.00%)、疼痛评分(1.57±0.50,1.52±0.61)、操作时间(min)(31.72±2.26,31.11±2.63)、留置时间(d)(200.24±62.42,203.77±65.84)比较,差异均无统计学意义(均P>0.05)。实验组和对照组患者的导管堵塞(5.17%,3.50%)、导管相关血栓(1.72%,4.50%)、导管穿刺点感染(1.72%,1.00%)及总并发症发生率(8.62%,9.00%)比较,差异均无统计学意义(均P>0.05)。结论超声引导下经大腿中部股静脉留置PICC导管安全可行,适用于肺癌并上腔静脉梗阻患者。Objective To determine the feasibility and complications of ultrasound-guided middle-thigh femoral vein PICC catheter,and provide basis for preferred vascular access in lung cancer patients with superior vena cava obstruction. Methods A retrospectively study was conducted in 258 patients with lung cancer chemotherapy. Fifty- eight patients receiving PICC insertion through ultrasound-guided middle-thigh femoral vein were recruited as the experimental group,while 200 patients receiving P1CC insertion through ultrasound-guided upper limb basilica vein were recruited as the control group. The successful rate of catheterization and the incidence of complications were compared between the two groups. Results The bleeding score in the experimental group（2.55±0.71） was lower than that of the control group（3.04±0.74）. The one-time insertion success rate in the experimental group was higher than that of the control group（98.28% versus 80.00%,P〈0.001）. No significant differences were found in the one-time puncture success rate（96.55% versus 96.00%）, pain score（1.57±0.50 versus 1.52_±0.61）,operation time（31.72±2.26 rains versus 31.11±2.63 mins）,retention time（200.24±62.42 days versus 203.77±65.84 days）,as well as the incidence of catheter occlusion（5.17% versus 3.50%）,catheter associated thrombosis（1.72% versus 4.50%）,puncture site infection （1.72% versus 1.00%） and total complications（8.62% versus 9.00%） between the two groups（P〉0.05）. Conclusion Ultrasound-guided middle-thigh femoral vein PICC catheter is safe and feasible for lung cancer patients with superior vena cava obstruction.

关 键 词：股静脉 肺肿瘤 上腔静脉梗阻 导管插入术 中心静脉 

分 类 号：R472[医药卫生—护理学]