环形扩皮法在血小板低下患者经外周静脉穿刺中心静脉置管中的应用  

Application of circular skin expansion method in central venous catheterization through peripheral venous puncture in patients with thrombocytopenia

作　　者：杨金芳 汪双月 王海萍 白嫣然 YANG Jinfang;WANG Shuangyue;WANG Haiping;BAI Yanran(Department of Breast Surgery,Xiangyang First People's Hospital Affiliated to Hubei University of Medicine,Hubei Province,Xiangyang441000,China)

机构地区：[1]湖北医药学院附属襄阳市第一人民医院甲乳外科,湖北襄阳441000

出　　处：《中国当代医药》2024年第22期184-186,192,共4页China Modern Medicine

基　　金：湖北省襄阳市第一人民医院科技创新项目(XYY 2023NA04)。

摘　　要：目的探讨超声引导下环形扩皮法在血小板低下患者经外周静脉穿刺中心静脉置管(PICC)中的临床应用效果。方法采用便利抽样法选取2022年5月至2023年7月湖北医药学院附属襄阳市第一人民医院PICC专科门诊收治的88例血小板低下患者作为研究对象,按照扩皮方式的不同将其分为对照组(n=43)和试验组(n=45),对照组采取常规扩皮方法,试验组采取20 ml注射器针头行360°环形扩皮,比较两组患者置管术中出血量和视觉模拟评分法(VAS),一次性送鞘成功率,置管后24 h穿刺点渗血渗液发生率,置管后7 d内导管维护次数。结果试验组扩皮即刻出血量低于对照组,差异有统计学意义(P<0.05);试验组VAS评分低于对照组,差异有统计学意义(P<0.05);试验组置管后24 h穿刺点渗血渗液发生率低于对照组,差异有统计学意义(P<0.05);试验组7 d内导管维护次数低于对照组,差异有统计学意义(P<0.05);两组一次性送鞘成功率,差异无统计学意义(P>0.05)。结论环形扩皮法有助于减少血小板低下的PICC置管患者出血量,降低渗血渗液发生率,减轻患者疼痛程度。Objective To investigate the clinical effect of ultrasound-guided circular skin dilation in patients with thrombocytopenia undergoing peripherally inserted central catheter(PICC).Methods A total of 88 patients with thrombocytopenia admitted to the PICC Specialist Clinic of Xiangyang First People's Hospital Affiliated to Hubei University of Medicine from May 2022 to July 2023 were selected by convenience sampling method and divided into control group(n=44)and experimental group(n=44)according to different skin expansion methods.The control group was treated with conventional skin expansion method,and the experimental group was treated with 360°circular skin expansion with 20 ml syringe needle.The amount of bleeding and visual analogue scale(VAS),the success rate of one-time sheath delivery,the incidence of bleeding and exudation at the puncture point 24 hours after catheterization,and the number of catheter maintenance within 7 days after catheterization were compared between the two groups.Results The immediate bleeding volume of the experimental group was lower than that of the control group,with statistically significant difference(P<0.05).The VAS score of the experimental group was lower than that of the control group,with statistically significant difference(P<0.05).The incidence of puncture point bleeding and exudation 24 hours after catheterization in the experimental group was lower than that of the control group,with statistically significant difference(P<0.05).The number of catheter maintenance within 7 days in the experimental group was lower than that of the control group,with statistically significant difference(P<0.05).There was no statistically significant difference in the success rate of one-time sheath delivery between the two groups(P>0.05).Conclusion The ring skin expansion method can help reduce the bleeding volume of patients with low platelet count and PICC catheterization,reduce the incidence of blood and fluid exudation,and relieve the pain of patients.

关 键 词：经外周静脉穿刺中心静脉置管 扩皮 血小板低下 出血 

分 类 号：R472[医药卫生—护理学]