经颈胸部长段皮下隧道-颈内静脉-中心静脉导管植入术围术期研究  

Perioperative study of catheterization via cervical and thoracic subcutaneous tunnel-internal jugular vein-central vein

作　　者：王凤玲[1] 马艳娜 孟庆波[3] 王国兴[4] 丁力军[4] 张继峰[4] 刘铁山[4] WANG Fengling;MA Yanna;MENG Qingbo;WANG Guoxing;DING Lijun;ZHANG Jifeng;LIU Tieshan(Department of Nursing,People′s Hospital of Zunhua,Zunhua,Hebei 064200,China;Department of Pediatrics,People′s Hospital of Zunhua,Zunhua,Hebei 064200,China;Department of Interventional Radiography,People′s Hospital of Zunhua,Zunhua,Hebei 064200,China;CT/MRI Room,People′s Hospital of Zunhua,Zunhua,Hebei 064200,China)

机构地区：[1]遵化市人民医院护理部,河北遵化064200 [2]遵化市人民医院儿科,河北遵化064200 [3]遵化市人民医院介入科,河北遵化064200 [4]遵化市人民医院CT/MRI室,河北遵化064200

出　　处：《重庆医学》2019年第15期2598-2602,共5页Chongqing medicine

基　　金：河北省医学科学研究重点课题(20171403)

摘　　要：目的比较经颈胸部长段皮下隧道-颈内静脉-中心静脉导管植入术(LSJICC)与中心静脉导管(CVC)植入术的临床效果。方法选取2015年1月至2017年12月该院确诊需进行中心静脉置管建立静脉通路,且外周静脉穿刺中心静脉置管(PICC)术不适用的患者336例,分为观察组(n=163)与对照组(n=173)。观察组行LSJICC,对照组行CVC植入术,比较两组术中及术后相关指标。观察组患者随访1年,观察治疗后的并发症发生情况及导管留置时间,并绘制Kaplan-Meier生存曲线。结果观察组导管留置时间较对照组长(P<0.05),达1年左右。观察组并发症总发生率明显低于对照组(P<0.05);两组导管移位、导管堵塞的发生率比较,差异均无统计学意义(P>0.05);观察组导管相关感染、血栓性静脉炎及穿刺出血或血肿的发生率低于对照组,差异均有统计学意义(P<0.05)。结论LSJICC为静脉置管提供了新通路,相较于CVC植入术能降低并发症的发生率,并使导管的长期留置成为可能。Objective To compare the clinical efficacy between the central venous catheterization via cervical and thoracic subcutaneous tunnel-internal jugular vein-central vein(LSJICC)and the central venous catheter(CVC)implantation.Methods A total of 336 patients who were not suitable for peripheral venous puncture central venous catheter(PICC)but requiring central venous catheterization to establish venous access in this hospital from January 2015 to December 2017 were selected and divided into the observation group(n=163)and the control group(n=173).The observation group performed LSJICC,and the control group underwent CVC implantation.The intraoperative and postoperative related indexes were compared between the two groups.Patients in the observation group were followed up for 1 year.The postoperative complications and catheter indwelling time were observed,and the Kaplan-Meier survival curve was drawn.Results The catheter indwelling time in the observation group was longer than that in the control group(P<0.05),which was about 1 year.The total incidence rate of complications in the observation group was significantly lower than that in the control group(P<0.05).There was no significant difference in the incidence rate of catheter displacement and catheter occlusion between the two groups(P>0.05).The incidence rates of catheter-related infection,thrombophlebitis and puncture hemorrhage or hematoma in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion LSJICC provides a new pathway for venous catheterization that could reduce the incidence of complications and make long-term catheter retention possible compared with CVC.

关 键 词：经颈胸部长段皮下隧道-颈内静脉-中心静脉导管植入术 导管插入术 中心静脉 PICC 颈胸部长段皮下隧道 并发症 

分 类 号：R472[医药卫生—护理学]