脐静脉置管联合PICC置管方案在早产儿肠外营养支持中的效果研究  

Application effect of umbilical vein catheter combined with PICC catheter in parenteral nutrition support for preterm infants

作　　者：朱稚玉 汤晓丽 沙莎 金倩 ZHU Zhiyu;TANG Xiaoli;SHA Sha;JIN Qian(Department of Neonatology,Shanghai Children's Medical Center,Shanghai 200127;Nursing Department,Shanghai Children's Medical Center,Shanghai 200127)

机构地区：[1]上海儿童医学中心新生儿科,上海200127 [2]上海儿童医学中心护理部,上海200127

出　　处：《护士进修杂志》2022年第4期289-293,共5页Journal of Nurses Training

基　　金：上海申康医院发展中心临床三年行动计划资助(编号:SHDC2020CR4098);上海交通大学医学院护理高原学科建设科研型临床护士培养基金(编号:Hlgy1802kyx)。

摘　　要：目的评价脐静脉置管(UVC)联合PICC置管方案在早产儿肠外营养静脉治疗中的临床应用效果,并从卫生经济学角度进一步评价此方案。方法选取2018年7月-2019年12月入住我院NICU符合中心静脉置管指征的97例早产儿,采取前后对照试验,将2018年7月-2019年3月入组的49例患儿作为对照组;2019年4-12月入组的48例患儿作为观察组。观察组使用UVC联合PICC置管方案,对照组使用PICC置管方案;评价2组患儿中心静脉临床应用效果及成本效果比。结果观察组PICC尖端位置达上腔静脉率为83.3%,高于对照组61.2%(P<0.05);2组中心静脉置管带管总天数及其相关并发症发生率与中心静脉带管时长偏移度差异均无统计学意义(P>0.05)。观察组中心静脉使用开始日龄及胎龄周均早于对照组(P<0.01);且观察组肠外营养支持(TPN)治疗开始日龄及胎龄周均早于对照组(P<0.05)。观察组肠外营养治疗期间成本效果比低于对照组,差异有统计学差异(P<0.05)。结论UVC联合PICC方案为早产儿生后早期提供了一条安全且有效的中心静脉通路,更契合早产生后早期TPN的治疗需求;综合卫生经济学评价指标,此方案的成本效果比优于PICC置管方案。Objective To investigate the clinical application effects,as well as the cost-effectiveness of nursing combined with UVC and PICC in premature infants.Methods A total of 97 premature infants who were divided into experimental group(n=48)and control group(n=49).The experimental group were received infusion therapy via UVC and PICC,while the control group were received infusion therapy via PICC.Measurements were collected to compare the infusion effects through central-line,including dwell time,complications,parenteral nutrition intravenous support and CER(cost-effectiveness indicator).Results The rate of PICC tip reaching superior vena cava was significantly higher in the experimental group than that in control group(P<0.05).In addition,the infants in the experimental group received earlier central-line catheterization(P<0.01),as well as earlier TPN treatment than those in the control group,respectively(P<0.05).Furthermore,the CER of the experimental group was lower than the control group.Conclusion Nursing treatment combined with UVC and PICC in premature infants could meet more needs of clinical treatment,and increase cost-effectiveness.

关 键 词：早产儿 新生儿重症监护室 脐静脉 经外周穿刺中心静脉置管 护理 成本效率 卫生经济学 

分 类 号：R473.72[医药卫生—护理学]