肝衰竭患者PICC置管渗血控制方法的研究

目的 探讨肝衰竭患者PICC置管后减少渗血的有效方法.方法 将198例肝衰竭患者按照时间顺序分为对照组96例与观察组102例.对照组按常规方法穿刺,加压固定,术后24 h换药;观察组穿刺方法为穿刺针进皮后,在皮下移行2.0～3.5 cm再入血管,术后根据凝血酶原活动度采用不同加压固定方法,对Ⅱ度以下的渗血72 h后换药.结果 观察组PICC置管后24 h与48h渗血分度显著轻于对照组(均P＜0.01).结论 PICC置管穿刺时延长皮下移行长度、术后根据凝血酶原活动度采用不同加压固定方法、适时予以换药,能有效减轻肝衰竭患者术后渗血.

Methods for reducing hemorrhage associated with PICC insertion in patients with liver failure

Objective To investigate effective methods for reducing bleeding at the puncture site after PICC insertion in patients with liver failure. Methods A total of 198 patients with liver failure were randomly divided into a control group(n=96) and an observation group(n=102) according to chronological order.In the control group,conventional method by which blood vessel was punctured directly with a puncture needle was employed,the puncture point was pressurized,and dressing change was conducted at postoperative 24 h.As for the observation group,the puncture needle was advanced into subcutaneous tissues for 2.0 to 3.5 cm,and then blood vessel was punctured;the puncture site was compressed by using different methods according to patients’ prothrombin activity;dressing change for hemorrhage being less than level 2 was conducted at postoperative 72 h. Results A lower degree of postoperative bleeding at the puncture site was found in the observation group than the control group at postoperative 24 h and 48 h(P<0.01 for both). Conclusion Postoperative bleeding resulting from PICC insertion in patients with liver failure can be effectively reduced by extending length of puncture needle passing through subcutaneous layer,compressing puncture site according to patients’ prothrombin activity,and opportunely by conducting dressing change.