普外科中心静脉置管并发症的原因分析及护理

目的分析普外科中心静脉置管常见并发症的发生原因，针对各个环节制订出相应护理细节，降低并发症的发生。方法对宜昌市中心人民医院2010年1月～2013年1月收治的胃癌及结直肠癌患者490例行中心静脉置管，将其为对照组（240例）和改进组（250例），对照组每天在输液开始时更换无菌透明敷贴，用O．5％碘伏棉签消毒，用3M公司的6cm×7cm透明敷贴将导管末端向上固定；改进组由专人定时每周更换1次敷贴及肝素帽，使用一次性护理包消毒，用3M公司的10．0cm×11．5em的透明敷贴将导管末端呈半圆形顺应胸骨方向向下固定。对置管并发症的发生率进行统计，分析发生并发症的原因及预防方法。结果对照组发生并发症96例，发生率为40．00％：改进组发生并发症12例，无空气栓塞、脱管等严重并发症发生，发生率为4．80％。改进组并发症发生率明显低于对照组，差异有统计学意义（P＜0．05）。结论中心静脉置管并发症的发生主要由于护理操作不当和护士责任心不强引起。重视护理细节，可以有效预防中心静脉并发症的发生，甚至避免严重并发症的发生。

Analysis of the causes of central venous catheterization complications and nursing countermeasures in general surgery

Objective To reduce the risk of common complications of central venous catheterization through analyzing the causes of central venous catheterization complications in general surgery, and drawing up corresponding nursing details directed at every segment. Methods A total of 490 cases of patients with gastric carcinoma and rectal carcinoma admitted to Yichang Central People＇s Hospital from January 2010 to January 2013 were taken central venous catheteri- zation. They were randomly assigned to the control group （240 cases） and the improvement group （250 cases）. For the control group, the patients were changed aseptic transparent dressings at the beginning of transfusion as routine that was normally disinfected with 0.5% iodophor cotton buds. And then the end of the catheter was fixed upward with 6 crux 7 cm transparent dressings of 3M company. For the improvement group, the patients were changed dressings and heparin lock regularly by specially-assigned person, usually once a week. They were first disinfected with disposable nursing packet, and then the end of the catheter was fixed downward toward the breastbone in semicircle with 10.0 cm×l 1.5 em transparent dressings of 3M company. The incidence of complications of catheterization was counted the causes and the preventions of complications of catheterization were analyzed. They were compared with the chi-square test, and it has statistical sense. Results 96 patients of complications occurred in control group, including aeroembolism, thrombus, infection and trachea cannula exodus. The rate of complications was 40.00%. While in the improvement group, 12 patients of complications occurred, which were only in thrombus and infection, without any severe complications, like aeroembolism and trachea cannula exodus patients. The rate of complications was 4.80%. The complication rate in the improvement group was obviously less than the control group, which has a statistically significant difference （P 〈0.05）. Conclusion The causes of central venous cathet