超声引导下结合改良塞丁格技术进行上臂静脉导入中心静脉置管的应用

目的探讨彩色多普勒超声引导下结合改良塞丁格技术进行上臂静脉导人中心静脉置管术（PICC）的临床使用情况及安全性。方法选择沈阳医学院附属中心医院2010年1月～2013年12月收治的，采用彩色多普勒超声引导下结合改良塞丁格技术行PICC的患者100例作为观察组，另选择同期收治的采用常规穿刺行PICC的患者100例作为对照组，观察并记录两组患者置管术过程中出血量、导管留置时间、贵要静脉及其他静脉使用情况、肘上下适用情况、置管成功率及并发症发生情况。结果两组患者肘上下穿刺置管使用率差异均有统计学意义（P〈0．05）：观察组肘上下适用分别为96例和100例，对照组肘上下适用分别为11例和66例，观察组适用率高于对照组，两组比较差异有统计学意义（P〈0．05）。观察组和对照组患者贵要静脉利用情况分别为89例和62例．两组比较差异有统计学意义（P〈0．05）。观察组和对照组导管留置时间分别为（195±18），（136±14）d，两组比较差异有统计学意义（P〈0．05）。观察组患者1次置管成功率为93．0％，对照组1次置管成功率为56．0％，两组比较差异有统计学意义（X^2=11．082，P〈0．05）；观察组患者置管总成功率为100．0％，对照组置管总成功率为76．0％，两组比较差异有统计学意义（X^2=9．129，P〈0．05）。观察组并发症发生率为4．0％，对照组并发症发生率为13．0％。结论彩色多普勒超声引导下结合改良塞丁格技术进行上臂静脉导入PICC术极大地提高置管成功率，减少导管并发症，增加导管置管时间，可在临床推广使用。

Application of ultrasonic guidance combined with modified seldinger tech- nique in peripherally inserted central catheter from upper arm vein

Objective To investigate the clinical applications and safety of ultrasonic guidance combined with modified seldinger technique in peripherally inserted central catheter （PICC） fiom upper arm vein. Methods 100 patients given PICC by ultrasonic guidance combined with modified seldinger technique from January 2010 to December 2013 in the Center Hospital Affiliated to Shenyang Medical College were selected as observation group, and in the same time, 100 cases given the conventional puncture were selected as control group. The bleeding loss during the catheterization, catheter indwelling time, basilic vein and other veins usage, elbow up/down puncture applicable conditions, cannulation success rate and complications incidence of two groups were observed and compared. Results The elbow up/down puncture catheterization utilization rate of two groups were compared, the difference was statistically significant （P 〈 0.05）. In observation group, the elbow up/down applicable puncture were 96 and 100 cases, and in control group those were 11 cases and 66 cases, the applicable rate of observation group was higher, the difference was statistically signifi- cant （P 〈 0.05）. The catheter indwelling time of observation group and control group were （195±18）, （136±4） d, the difference was statistically significant （P 〈 0.05）; the basilic vein used in observation group and control group were 89 and 62 cases, the difference was statistically significant （P 〈 0.05）. The once catheterization success rate of observation group and control group were 93.0% and 56.0%, the difference was statistically significant （X^ 2 = 11.082, P 〈 0.05）; the total catheterization success rate of observation group and control group were 100.0% and 76.0%, the difference was statistically significant （X^2 = 9.129, P 〈 0.05）. The incidence of complications of observation group and control group were 4.0% and 13.0%. Conclusion Color Doppler ultrasonic guidance combined with modified seldinger technique can greatly improve the success rate of PICC from upper arm vein, reduce catheter complications, increase catheters in- dwelling time, it is worthy of clinical promotion.