王璇

[摘要] 目的 比較超聲引導(dǎo)下改良Seldinger技術(shù)行PICC置管與傳統(tǒng)穿刺置管的應(yīng)用效果。 方法 選擇沈陽醫(yī)學(xué)院附屬中心醫(yī)院2010年6月～2013年12月門診或住院需要進(jìn)行PICC置管的患者280例，隨機(jī)分為兩組，各140例。研究組患者采用超聲引導(dǎo)下改良Seldinger技術(shù)經(jīng)上臂行PICC置管，對(duì)照組患者采用傳統(tǒng)穿刺方法進(jìn)行PICC置管。觀察兩組患者一次穿刺成功率、一次置管成功率、總置管成功率，觀察貴要靜脈使用情況、置管后導(dǎo)管末端位置及相關(guān)并發(fā)癥情況。 結(jié)果 研究組一次穿刺成功率、一次置管成功率及總置管成功率明顯高于對(duì)照組（99.3%、97.8%、99.3%比80.0%、77.8%、88.6%），組間比較差異均有統(tǒng)計(jì)學(xué)意義（χ2=6.395、6.843、4.283，P < 0.05）。兩組穿刺靜脈及導(dǎo)管末端位置比較差異有統(tǒng)計(jì)學(xué)意義（χ2=7.209、4.375，P < 0.05）。研究組導(dǎo)管留置時(shí)間長于對(duì)照組[（162±20）d比（124±17）d]，差異有統(tǒng)計(jì)學(xué)意義（t=5.794，P < 0.05）。研究組靜脈炎、靜脈血栓、周圍組織損傷發(fā)生率明顯低于對(duì)照組（P < 0.05），兩組穿刺點(diǎn)滲血、導(dǎo)管相關(guān)感染發(fā)生率差異無統(tǒng)計(jì)學(xué)意義（P > 0.05）。 結(jié)論 超聲引導(dǎo)下改良Seldinger技術(shù)行PICC置管可有效提高穿刺及置管成功率，且導(dǎo)管異位及穿刺相關(guān)并發(fā)癥發(fā)生率明顯降低，安全性較高，值得推廣應(yīng)用。

[關(guān)鍵詞] 超聲引導(dǎo)；改良Seldinger技術(shù)；經(jīng)外周靜脈置入中心靜脈導(dǎo)管；靜脈穿刺

[中圖分類號(hào)] R473 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1673-7210（2014）09（a）-0050-05

[Abstract] Objective To compare the effect of ultrasound-guided peripherally inserted central catheter （PICC） under modified Seldinger technique and traditional PICC. Methods 280 cases of outpatients and inpatients required PICC in Central Hospital Affiliated to Shenyang Medical College from June 2010 to December 2013 were randomly divided into two groups， each of 140 cases. Patients of study group were given ultrasound-guided PICC on upper arm under modified Seldinger technique， and patients in control group were given traditional PICC. One time puncture success rate， one time catheter success rate， total catheter success rate， the usage condition of basilic vein， tip position of catheter， and related complications of two groups were observed and compared. Results The one time puncture success rate， one time catheter success rate， total catheter success rate of study group were significantly higher than those of control group （99.3%， 97.8%， 99.3% vs 80.0%， 77.8%， 88.6%）， the differences between the two groups were statistically significant （χ2=6.395， 6.843，4.283， P < 0.05）. The usage condition of puncture veins and tip position of catheter were compared between the two groups， the differences were statistically significant （χ2=7.209， 4.375， P < 0.05）. Catheter indwelling time of study group was longer than the control group [（162±20） d vs （124±17） d] （t=5.794， P < 0.05）. The occurrence rates of phlebitis， venous thrombosis， peripheral tissue damage of study group were significantly lower than those of the control group （P < 0.05）， occurrence rates of puncture point bleeding， catheter-related infection between the two groups had no significantly different （P > 0.05）. Conclusion Ultrasound-guided PICC under modified Seldinger technique can effectively improve the success rate of puncture and catheterization， reduce the incidence of catheter-related complications and ectopic catheter， had high security， which should be widely applied.endprint