颈内静脉置管与股静脉置管在肝衰竭患者人工肝治疗中的应用比较  

Application comparison between internal jugular vein catheterization and femoral vein catheterization in artificial liver support system in patients with liver failure

作　　者：陈芳[1] 许艳[1] 周少群[1] 白浪[1] 马元吉[1] Chen Fang;Xu Yan;Zhou Shaoqun;Bai Lang;Ma Yuanji(Center of Infectious Diseases,West China Hospital of Sichuan University,Chengdu 610041,Sichuan,China)

机构地区：[1]四川大学华西医院感染性疾病中心,四川成都610041

出　　处：《中国中西医结合急救杂志》2019年第6期688-690,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家科技重大专项示范区项目(2018ZX10715003)。

摘　　要：目的 探讨肝衰竭患者人工肝支持系统(ALSS)治疗的置管方式及其优缺点.方法 回顾性分析四川大学华西医院感染性疾病中心传染科人工肝室2015年1月至2017年5月行ALSS治疗的肝衰竭患者279例的临床资料,其中颈内静脉置管组147例,股静脉置管组132例.比较两组患者穿刺成功率、并发症发生率及舒适度的差异.结果 颈内静脉置管组和股静脉置管组首针穿刺成功率比较差异无统计学意义[95.92%(141/147)比91.67%(121/132),均P>0.05];颈内静脉置管组导管相关性感染、堵管、非计划性拔管发生率均明显低于股静脉置管组[导管相关性感染:1.36%(2/147)比6.82%(9/132),堵管:1.36%(2/147)比15.91%(21/132),非计划性拔管:0.68%(1/147)比6.82%(9/132),均P<0.05];颈内静脉置管组和股静脉置管组出血和血肿、深静脉血栓形成及血胸等并发症发生率比较差异均无统计学意义[出血和血肿:4.08%(6/147)比8.33%(11/132),深静脉血栓形成:0 (0/147)比1.52%(2/132),血胸:0.68%(1/147)比0(0/132),均P>0.05].颈内静脉置管组中重度依赖的自理能力、排便困难、活动受限、失眠等方面的比例均较股静脉置管组降低[中重度依赖的自理能力:63.27%(93/147)比79.55%(105/132),排便困难:16.33%(24/147)比48.48%(64/132),活动受限:11.56%(17/147)比71.21%(94/132),失眠:15.65%(23/147)比47.00%(62/132),均P<0.05].结论 颈内静脉置管方式整体优于股静脉置管,在肝衰竭患者人工肝治疗中值得推广,但由于颈内静脉穿刺难度较大,对置管医生要求较高,故在行颈内静脉置管时,需要经验丰富的医生在B超引导下进行.Objective To observe the advantages and disadvantages of different kinds of catheterization in artificial liver support system(ALSS)in patients with liver failure.Methods A retrospective analysis was conducted on 279 patients with liver failure who received ALSS treatment in the Center of Infectious Diseases,West China Hospital of Sichuan University from January 2015 to May 2017,the clnical data was compared between two groups.The study cohort included 147 patients with the internal jugular vein catheterization and 132 patients with the femoral vein catheterization.The rate of puncture success,complication incidence and the patients'comfort degree were compared between the two groups.Results There was no significant difference in the success rate of first puncture between the two groups[95.92%(141/147)vs.91.67%(121/132),P>0.05];the incidence of catheter related infection,catheter plugging and unplanned extubation in the internal carotid vein catheterization group were significantly lower than those in the femoral vein catheterization group[the incidence of catheter related infection:1.36%(2/147)vs.6.82%(9/132),catheter plugging:1.36%(2/147)vs.15.91%(21/132),unplanned extubation:0.68%(1/147)vs.6.82%(9/132),all P<0.05];there were no statistical significant differences in the incidences of bleeding and hematoma,deep vein thrombosis and hemothorax between the internal jugular vein catheterization group and the femoral vein catheterization group[bleeding/hematoma:4.08%(6/147)vs.8.33%(11/132),deep vein thrombosis:0(0/147)vs.1.52%(2/132),hemothorax:0.68%(1/147)vs.0(0/132),all P>0.05].The comfort degrees of patients concerning the movement,sleep,moderately and heavily dependent self-care ability,defecation in the internal jugular vein catheterization group were lower than those of the femoral vein catheterization group[moderately and heavily dependent self-care ability:63.27%(93/147)vs.79.55%(105/132),defecation difficulty:16.33%(24/147)vs.48.48%(64/132),activity limitation:11.56%(17/147)vs.71.21%(94/132),insomnia:15.65%

关 键 词：颈内静脉置管 股静脉置管 肝衰竭 人工肝支持系统 应用比较 

分 类 号：R47[医药卫生—护理学]