完全植入式静脉输液港与经外周静脉穿刺中心静脉置管在儿童化疗中的个体化选择  

Individualized selection of totally implantable vein port and peripheral inserted central catheter in children's chemtherapy

作　　者：郭宏溪 卞红强[1] 彭飞 GUO Hongxi;BIAN Hongqiang;PENG Fei(Department of General Surgery,Wuhan Children's Hospital(Wuhan Maternal and Child Healthcare Hospital),Tongji Medical College,Huazhong University of Science&Technology,Hubei Wuhan 430015,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院(武汉市妇幼保健院)普外科,湖北武汉430015

出　　处：《现代肿瘤医学》2022年第16期2986-2990,共5页Journal of Modern Oncology

摘　　要：目的:探讨恶性肿瘤患儿最合适的深静脉导管置管方式。方法:回顾性分析2013年1月至2019年8月收治的412例长期深静脉置管肿瘤患儿的临床资料。接受完全植入式静脉输液港(totally implantable venous access port,TIVAP)患儿156例,男88例,女68例,为TIVAP组;接受经外周静脉穿刺中心静脉置管(peripherally inserted central catheter,PICC)患儿256例,男157例,女99例,为PICC组。对比两组患儿年龄、置管费用、一次性置管成功率及置管时间、置管操作中并发症发生率、留置时间、置管后并发症发生率及提前拔管发生率。结果:TIVAP组患儿年龄明显低于PICC组(P<0.05),但费用却明显高于PICC组(P<0.05);TIVAP组的一次性置管成功率略低于PICC组(P<0.05),两组置管时间及置管操作中并发症发生率无统计学差异(P>0.05);TIVAP组留置时间明显长于PICC组(P<0.05);PICC组患儿置管后并发症发生率及提前拔管发生率均随着时间的延长而逐渐增加(P<0.05);TIVAP组患儿置管后并发症发生率也随着时间延长而增加(P<0.05),但提前拔管发生率增加无统计学意义(P>0.05);置管后的前六个月,TIVAP组置管后并发症发生率及提前拔管发生率与PICC组无明显差异(P>0.05);而置管六个月后,TIVAP组发生率则明显低于PICC组(P<0.05)。结论:TIVAP和PICC两种深静脉置管方式各有优缺点。对于低年龄儿童、化疗时间长于6月、患儿及家属依从性较差的的恶性肿瘤患儿,我们建议优先选择TIVAP,但临床医生应综合考虑各方面因素,为患儿选择个体化深静脉导管留置方式。Objective:To explore the most suitable deep vein catheterization method for children with malignant tumors.Methods:We conducted a retrospective study on the clinical data of 412 children with malignancy who received long-term deep vein catheterization from January 2013 to August 2019.There were 156 children with TIVAP,88 males and 68 females.There were 256 children with PICC,157 males and 99 females.The age of the children,the charge of the catheter,successful one-time catheterization rate,the time of implanting the catheter,the incidence of complication during implanted the catheter,retention time,incidence of complication after implanted the catheter,and premature extubation rate were compared between the two groups.Results:The age of TIVAP group was significantly lower than that of PICC group(P<0.05),but the cost was significantly higher than that of PICC group(P<0.05).The successful one-time catheterization rate in TIVAP group was slightly lower than that in PICC group(P<0.05).There was no significant difference in the time of implanting the catheter and the incidence of complication during implanted the catheter between the two groups(P>0.05).The retention time of TIVAP group was significantly longer than that of PICC group(P<0.05).The incidence of complication after implanted the catheter and premature extubation in the PICC group were significantly increased with the prolongation of time(P<0.05),the incidence of complication after implanting in the TIVAP group also increased with time(P<0.05),but the incidence of premature extubation was not statistically significant(P>0.05).The first six months after the tube,the incidence of complications after catheterization and premature extubation in the TIVAP group were no significantly different from those in the PICC group(P>0.05),and after six months,the incidence of TIVAP group was significantly lower than that of PICC group(P<0.05).Conclusion:TIVAP and PICC have their own advantages and disadvantages.We suggest that TIVAP should be preferred for children with l

关 键 词：儿童 恶性肿瘤 植入式静脉港 经外周静脉穿刺中心静脉置管 化疗 输液 

分 类 号：R730.5[医药卫生—肿瘤]