碳酸氢钠溶液封管预防经外周静脉置入中心静脉导管纤维蛋白鞘堵塞的应用研究  

Application of sodium bicarbonate solution for flushing to prevent fibrin sheath blockage of peripherally inserted central catheter

作　　者：江岱琪[1] 邓国瑜 李玲玲 黎容清[1] Jiang Daiqi;Deng Guoyu;Li Lingling;Li Rongqing(Head and Neck Radiotherapy Second Ward,Affiliated Tumor Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学附属肿瘤医院头颈放疗二病区,南宁530021

出　　处：《中国实用护理杂志》2025年第10期749-753,共5页Chinese Journal of Practical Nursing

基　　金：广西医疗卫生适宜技术开发与推广应用项目(S2022115);广西壮族自治区卫生健康委员会自筹经费科研课题(Z-A20220737)。

摘　　要：目的探讨碳酸氢钠溶液封管在预防经外周静脉置入中心静脉导管(PICC)纤维蛋白鞘堵塞的可行性及安全性,为PICC维护提供参考。方法2022年6月至2023年9月,采用随机对照研究,以便利抽样法选择于广西医科大学附属肿瘤医院行PICC的96例患者为研究对象。按随机数字表法分为对照组和观察组。2组患者均采用握力球握拳锻炼置管上肢,导管维护时,2组均使用0.9%氯化钠溶液10 ml脉冲式冲洗导管,对照组采用0.9%氯化钠溶液10 ml正压封管,观察组采用5%碳酸氢钠溶液3 ml正压封管。置管后第1天和第1、2、3、4、5个月时,统计2组患者导管"机械活瓣"、导管堵塞发生情况,比较血碳酸氢根浓度和白细胞介素6(IL-6)水平。结果最终纳入92例PICC患者;对照组45例,男28例,女17例,年龄27~65(43.80±2.21)岁;观察组47例,男29例,女18例,年龄28~64(43.80±2.25)岁。观察组置管后"机械活瓣"总发生率为2.1%(1/47),低于对照组的26.7%(12/45),差异有统计学意义(χ^(2)=11.41,P<0.05);观察组置管后导管堵塞发生率为2.1%(1/47),低于对照组的15.5%(7/45),差异有统计学意义(χ^(2)=5.22,P<0.05);观察组置管后第2、3、4、5个月IL-6分别为(4.53±0.62)、(4.68±0.59)、(4.76±0.57)、(4.83±0.53)ng/L,均低于对照组的(4.83±0.59)、(4.95±0.54)、(5.21±0.48)、(5.63±0.57)ng/L,差异均有统计学意义(t值为2.26~6.86,均P<0.05);2组不同时间点血碳酸氢根浓度比较差异均无统计学意义(均P>0.05)。结论碳酸氢钠溶液封管能有效预防PICC纤维蛋白鞘堵塞,并能降低患者血清IL-6水平,是一种安全有效的封管方式。Objective To explore the feasibility and safety of sodium bicarbonate solution for flushing in preventing fibrin sheath occlusion in peripherally inserted central catheters(PICC),providing a reference for PICC maintenance.MethodsA randomized controlled study was conducted from June 2022 to September 2023.Convenience sampling was used to select 96 patients who underwent PICC at the Affiliated Tumor Hospital of Guangxi Medical University.The patients were randomly divided into a control group and an observation group.Both groups performed grip strength exercises using a grip ball on the catheterized upper limb.During catheter maintenance,both groups used 10 ml of 0.9%sodium chloride solution for pulsed flushing.The control group used 10 ml of 0.9%sodium chloride solution for positive pressure flushing,while the observation group used 3 ml of 5%sodium bicarbonate solution for positive pressure flushing.The incidence of"mechanical valve"and catheter occlusion,as well as blood bicarbonate concentration and interleukin-6(IL-6)levels,were recorded on the first day and at 1,2,3,4,and 5 months after catheterization.ResultsA total of 92 PICC patients were included,with 45 in the control group,28 males and 17 females,aged(43.80±2.21)years old,and 47 in the observation group,29 males and 18 females,aged(43.80±2.25)years old.The total incidence of"mechanical valve"in the observation group was 2.1%(1/47),lower than the control group′s 26.7%(12/45),the difference was statistically significant(χ^(2)=11.41,P<0.05).The incidence of catheter occlusion in the observation group was 2.1%(1/47),lower than the control group's 15.5%(7/45),the difference was statistically significant(χ^(2)=5.22,P<0.05).The IL-6 levels in the observation group at 2,3,4,and 5 months after catheterization were(4.53±0.62),(4.68±0.59),(4.76±0.57),and(4.83±0.53)ng/L,respectively,lower than the control group(4.83±0.59),(4.95±0.54),(5.21±0.48),and(5.63±0.57)ng/L,the differences were statistically significant(t values were 2.26-6.86,all P<0.05).There

关 键 词：导管插入术 中心静脉 碳酸氢钠 白细胞介素6 封管溶液 纤维蛋白鞘 导管堵塞 血碳酸氢根 

分 类 号：R472[医药卫生—护理学]