一种新的中心静脉导管固定方法在重症医学科中的应用  

Application of a new fixation method of central venous catheter in intensive care unit

作　　者：赵建祥[1,2,3] 陈雪梅 陈锋 于荣国[1,2] 柯俊 龚书榕[1,2] Zhao Jianxiang;Chen Xuemei;Chen Feng;Yu Rongguo;Ke Jun;Gong Shurong(The Third Department of Critical Care Medicine,Fujian Provincial Hospital,Fuzhou 350001,China;Shengli Clinical Medical College of Fujian Medical University,Fuzhou 350001,China;Fujian Provincial Key Laboratory of Emergency Medicine,Fuzhou 350001,China;Department of Emergency,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建省立医院重症医学三科,福州350001 [2]福建医科大学省立临床学院,福州350001 [3]福建省急诊医学重点实验室,福州350001 [4]福建省立医院急诊科,福州350001

出　　处：《创伤与急诊电子杂志》2021年第4期238-244,共7页Journal of Trauma and Emergency(Electronic Version)

摘　　要：目的研究一种新的中心静脉导管(central venous catheter,CVC)固定方法(缝线交叉固定法)在重症医学科中的应用。方法对2019年11月至2020年11月福建省立医院重症医学三科收治的两组重症患者进行前瞻性、随机对照、单盲、干预性的临床研究。入重症医学科后根据CVC的使用指征,将患者分成缝线交叉固定组(n=52)和卡扣固定组(n=52),分别用缝线交叉固定导管和卡扣固定导管。在CVC置入后第3天和第5天评估导管移位、扭结、固定失效、计划外拔管、穿刺点红肿、脓性分泌物、穿刺部位皮肤微生物培养、导管相关血流感染等情况。结果在第5天缝线交叉固定组导管移位(4.00%)、扭结(4.00%)、固定失效(6.00%)和计划外拔管(4.00%)的发生率均低于卡扣固定(发生率分别为:16.67%、25.00%、25.00%、18.75%),差异均有统计学意义(P值分别为0.038、0.003、0.009、0.021)。两组间穿刺部位皮肤微生物培养阳性率和菌落计数差异均无统计学意义。两组均未发生导管相关血流感染。结论与常规的卡扣式固定方法相比,缝线交叉固定更可靠,减少了导管移位、扭结、固定失效和计划外拔管的发生率,而且不会增加穿刺部位感染的发生率。Objective To investigate the application of a new fixing method of central venous catheter (CVC) in intensive care unit (ICU).Method A prospective randomized controlled single-blind intervention clinical study was conducted in two groups of severe patients admitted to the Third Department of Critical Care Medicine of Fujian Provincial Hospital from November 2019 to November 2020.Patients were divided into cross-suture fixation group (n=52) and buckle-fixation group (n=52) according to the indications to the positioning of the central venous catheters.Catheter displacement,kink,fixation failure,unplanned extubation,redness and swelling at the puncture site,purulent secretions,skin microbial culture at the puncture site,and catheter-related bloodstream infections were evaluated on day 3 and 5 after CVC implantation.Result The incidence of catheter displacement (4.00% vs 16.67%,P=0.038),kink(4% vs 25%,P=0.003),fixation failure (6% vs 25%,P=0.009) and unplanned extubation (4% vs 18.7%,P=0.021) were lower in the cross-suture fixation group than in the buckle-fixation group.There was no significant difference in the positive rate of skin microbe culture and colony count between the two groups.No catheter-related bloodstream infections occurred in both groups.Conclusion Compared with the conventional fixation method,the cross-suture fixation is more reliable,as it could reduce the incidence of catheter displacement,kink,fixation failure and unplanned extubation,and didn’t increase the incidence of infection.

关 键 词：中心静脉导管 固定 重症医学 血流感染 

分 类 号：R472[医药卫生—护理学]