超声在PICC导管异位快速检测中的应用

目的探讨超声在PICC置管异位快速检测中的应用效果。方法选取进行经外周中心静脉置管的218例患者为研究对象，随机分为实验组114例，对照组104例。实验组在导管送入目标长度后立即用超声探头进行颈内静脉等常见异位静脉检测，发现有导管异位后立即进行位置调整再予固定和x线检查；对照组采用常规方法置管固定后行x线检查。如x线检查发现导管未处于标准位置，则安排患者返回置管室进行调整后再行x线检查确定位置。比较两组患者导管位置的正确率、患者满意度、置管时间、导管定位的检测费用及调管相关并发症发生率。结果导管位置正确率对照组（76．92％）低于实验组（96．49％），差异具有统计学意义（x^2=18.603，P〈0．01）；满意度评分实验组（4.717±0．524）分高于对照组（4．096±1．296）分，置管时间实验组（21．455±3．923）min低于对照组（24．123±7．184）min，差异均具有统计学意义（t分别为4．728，-4．603；P〈0．01）；相关并发症发生率对照组（30．769％）高于实验组（18．421％），差异具有统计学意义（X^2=4．507，P〈0．05）。结论采用超声进行置管过程中导管尖端异位快速检测可有效提高导管位置的正确率，节约置管时间，不增加患者经济负担，减少因调管导致的并发症发生率，有效提高HCC置管质量。

Application of ultrasound in rapid position detection of central venous catheterization

Objective To explore the application effect of ultrasound in rapid position detection of central venous catheterization. Methods Totals of 218 patients received central venous catheterization were randomly divided into experimental group （114 cases） and control group （104 cases）. The experimental group accepted ultrasonic testing before PICC catheter was fixed and examined by X-ray. The control group accepted traditional examination after catheter was fixed. The accuracy of catheterization position, patients＇ satisfaction, catheterization time, catheter detective costs, and ratio of catheter-adjusting related complications among both groups were collected and analysed. Results The rate of correct catheter positioning in the first time in experimental group was 96. 49% higher than control group which was 76. 92%, and the difference was statistically significant （ X2 = 18. 603 ,P 〈 0. 01 ）. Patients satisfaction score of experimental group was（4.717 ± 0.524） higher than control group that was （4. 096 ± 1. 296）. Catheterization time of experimental group was （21.455 ±3. 923）min lower than control group （24. 123 ± 7. 184）min, and the difference was statistically significant （ t = 4. 728, - 4. 603, respectively; P 〈 0. 05 ）. The rate of catheter-adjnsting related complications of experimental group was 18. 421% lower than 30. 769% in control group, and the difference was statistically significant （ X2 = 4. 507, P 〈 0. 05 ）. There was no significantly difference between two groups in catheter detective costs. Conclusions Application of ultrasound in rapid position detection of central venous catheterization can increase the accuracy of catheterization, save catheterization time, reduce the ratio of catheteradjusting related complications, effectively improve the quality of PICC without increase catheterization costs.