超低出生体重儿脐静脉导管留置时程与并发症发生的多中心研究  

A multicenter-based study of dwell time and complications of umbilical venous catheterization in extremely low-birth weight infants

作　　者：陈璐 华敏敏[2] 郑旭 杨子馨 彭亚光[3] 徐发林[2] 黑明燕 Chen Lu;Hua Minmin;Zheng Xu;Yang Zixin;Peng Yaguang;Xu Falin;Hei Mingyan(Neonatal Center,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China;Department of Neonatology,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Center for Clinical Epidemiology and Evidence-based Medicine,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心、首都医科大学附属北京儿童医院新生儿中心,北京100045 [2]郑州大学第三附属医院新生儿科,郑州450052 [3]国家儿童医学中心、首都医科大学附属北京儿童医院临床流行病与循证医学中心,北京100045

出　　处：《中华新生儿科杂志（中英文）》2024年第11期663-668,共6页Chinese Journal of Neonatology

基　　金：北京市卫生健康委员会首都卫生发展科研专项(2022-2-2095)。

摘　　要：目的探讨我国超低出生体重儿(extremely low-birth weight infant,ELBWI)脐静脉置管(umbilical venous catheterization,UVC)的留置时程及并发症情况。方法选择2019年11月至2021年8月在我国27家医院新生儿重症监护室住院并接受UVC的ELBWI进行回顾性研究。根据UVC实际留置时程分为短时程组(≤7 d)和长时程组(>7 d),比较两组患儿人口学资料、临床基线数据、UVC留置时程及相关并发症发生情况,对不同留置时程导管相关血流感染(central line-associated bloodstream infection,CLABSI)的发生情况进行线性趋势检验。结果共纳入458例ELBWI,胎龄(27.9±2.0)周,出生体重885(800,950)g,UVC留置时程为7(6,10)d,其中短时程组238例、长时程组220例。UVC常见的并发症为血栓/堵管、尖端移位和CLABSI。短时程组血栓/堵管(25.9/1000导管日、13.9%)和尖端移位(14.9/1000导管日、8.0%)发生率、百分率均明显高于长时程组(3.9/1000导管日、4.1%,0.4/1000导管日、0.5%),差异有统计学意义(P<0.05);两组CLABSI发生率和百分率差异无统计学意义(P>0.05)。留置时程1~6 d、7~10 d和≥11 d的CLABSI百分率分别为0.0%、2.7%和3.7%,线性趋势检验结果无统计学意义(P=0.051)。结论ELBWI的UVC留置时程一般为7 d,最常见的并发症是血栓/堵管,多在UVC留置1周内发生。Objective To study the dwell time and associated complications of umbilical venous catheterization(UVC)in extremely low-birth weight infants(ELBWIs)in China.Methods ELBWIs who were hospitalized in 27 hospitals'neonatal intensive care units in China and underwent UVC from November 2019 to August 2021 were enrolled.According to the actual dwell time of UVC,ELBWIs were categorized into the short-term group(≤7 d)and the long-term group(>7 d).Demographic information,clinical baseline data,UVC dwell time,and complications of the two groups were compared.A linear trend test was conducted to analyze the percentage of central line-associated bloodstream infection(CLABSI)at varying lengths of dwell time.Results A total of 458 ELBWIs were enrolled.They were born at a gestational age of(27.9±2.0)weeks,with a birth weight of 885(800,950)g.The median duration of UVC dwell time was 7(6,10)d,with 238 cases in the short-term group and 220 cases in the long-term group.The top three complications of UVC were thrombosis/blockage,migration,and CLABSI.The incidence and percentage of thrombosis/blockage and migration in the short-term group(25.9/1000 d vs.14.9/1000 d,13.9%vs.8.0%)were significantly higher than those in the long-term group(3.9/1000 d vs.0.4/1000 d,4.1%vs.0.5%)(P<0.05).The incidence and percentage of CLABSI did not exhibit a significant difference between the short-term and long-term groups(both P>0.05).The comparison of CLABSI percentages(0.0%,2.7%,and 3.7%),grouped according to actual length of dwell time as 1-6 d,7-10 d,and≥11 d,showed no significant linear trend(P=0.051).Conclusions The median dwell time of UVC for ELBWIs was 7 d,and the most common complication was thrombosis/blockage,which occurred mainly within 1 week from insertion.

关 键 词：新生儿 脐静脉置管 并发症 留置时程 超低出生体重 

分 类 号：R473.72[医药卫生—护理学]