B超引导下改良Seldinger技术行PICC在肺癌患者中的应用研究

目的探讨肺癌患者经外周静脉穿刺中心静脉置管(PICC)采用B超引导下改良股动脉穿刺(Seldinger)技术的临床效果。方法选取2011年1月至2016年5月在本院行PICC置管的295例肺癌患者作为研究对象,根据PICC置管方法将上述研究对象分为观察组(151例)与对照组(144例),观察组PICC置管采用B超引导下改良Seldinger技术,对照组PICC置管采用传统方法,现对比分析两组患者的静脉血栓发生情况。结果 (1)PICC置管前,两组患者血小板计数(PLT),血浆D-二聚体(DD)、血栓烷B2(TXB2)、内皮素(ET)、6-酮-前列腺素F1α(6-keto-PGF1α)相比差异无统计学意义(P0.05)。PICC置管前、PICC置管后12h、PICC置管后24h,观察组与对照组的PLT,血浆D-D、TXB2、ET均逐步升高,血浆6-keto-PGF1α均逐步下降,组内不同时间点比较差异均有统计学意义(P0.05)。PICC置管后12h、PICC置管后24h,观察组PLT,血浆D-D、TXB2、ET均显著低于对照组,6-keto-PGF1α均显著高于对照组,两组比较差异有统计学意义(P0.05)。(2)观察组静脉血栓发生率显著低于对照组,两组比较差异有统计学意义(P0.05)。结论肺癌患者PICC置管采用B超引导下改良Seldinger技术的静脉血栓发生率更低。

Study on application of B-type ultrasound guided modified Seldinger technique for PICC in patients with lung cancer

Objective To investigate the clinical effect of adopting B-type ultrasound guided peripherally inserted central catheter (PICC) in the patients with lung cancer.Methods Two hundreds and ninety-five cases of lung cancer undergoing PICC in our hospital from January 2011 to May 2016 were selected as the research subjects and divided into the observation group (151 cases) and control group (144 cases) according to the PICC methods.PICC in the observation group adopted the B-type guided modified Seldinger technique,while the control group adopted the conventional method.The venous thrombus occurrence situation in the two groups was comparatively analyzed.Results (1) The platelet count (PLT),plasma D dimer (D-D) and thromboxane B2 (TXB2),endothelin (ET),6-keto-prostaglandin F1 alpha (6-keto-PGF1α) before PICC had no signigicant difference between the two groups (P>0.05).PLT,D-D,TXB2 and ET at 12,24 h after PICC in the observation group and control group were gradually increased,while plasma 6-keto-PGF1α was gradually decreased,the intra-group difference among different time points had statistical significant (P<0.05).PLT and plasma D-D,TXB2 and ET in the observation group were significantly lower than those in the control group,while keto-PGF1α was significantly higher than that in the control group,the difference between the two groups was statistically significant(P<0.05).(2)The incidence rate of venous thrombosis in the observation group was significantly lower than that in the control group,the difference was statistically significant between the two groups (P<0.05).Conclusion Adopting B-type ultrasound guided modified Seldinger technique for PICC in the patients with lung cancer has much lower incidence rate of venous thrombosis.