乳腺癌根治术后患肢 PICC 置管的可行性分析

目的：探讨乳腺癌术后患者患肢经外周中心静脉置管（ PICC ）是否可行。方法选择60例乳腺癌改良根治术后需行PICC置管的患者作为研究对象，采用随机数字表法将患者分成观察组和对照组各30例。观察组在患肢进行置管，对照组在健肢进行置管。两组均由同一名专科护士根据标准操作程序行PICC。置管后由同一水平、同一资质的护士团队根据统一的《PICC患者健康教育路径表》和《PICC维护标准及并发症处理标准》进行护理。比较两组患者术后6个月患肢肩关节活动度、上肢水肿发生率、各种并发症的发生率及导管留置相关情况等指标。结果观察组1例患者发生患肢关节运动受限，29例正常；对照组2例患者发生患肢关节运动受限，28例正常，两组比较差异无统计学意义（ Z＝-0．587，P＝0．557）。观察组4例患者发生上肢水肿，其中轻度2例，中度2例；对照组3例患者发生上肢水肿，其中轻度1例，中度2例，两组比较差异无统计学意义（Z＝-0．408，P＝0．683）。观察组一次置管成功29例，对照组一次置管成功30例，差异无统计学意义（χ2＝1．017，P＝0．313）。两组在留置导管长度、外露长度、操作时间、导管留置时间方面差异无统计学意义（P＞0．05）。结论乳腺癌改良根治术后对患者的患侧上肢进行PICC置管可行。

Feasibility analysis of inserting PICC line in operative side upper limb of postoperative breast cancer patients

Objective To evaluate the feasibility of inserting peripherally inserted central catheter （ PICC） line in operative side upper limb of postoperative breast cancer patients .Methods A randomized clinical trial was conducted .Totally sixty postoperative patients receiving PICC were randomly divided into two groups.Patients in both groups were inserted PICC by standard procedure .Catheters in the observation group were inserted at the operative side upper limb .Catheters in the control group were inserted at healthy side upper limb.Nursing care was provided by one team of nurses to patients in both groups according to the unified “path of health education for patients with PICC” and“maintenance standards and complication treatment standards for PICC”. The mobility of shoulder after six months and the incidence of lymphedema , catheter-related complications were compared between groups .Results One patient in the observation group and two patients in the control had limitation of shoulder .There was no significant difference between groups （ Z=-0.587, P=0.557）.Four patients with mild in two cases and moderate in two cases in the observation group and three patients with mild in one case and moderate in two cases in the control group had lymphedema .There was also no significant difference between the two groups （Z =-0.408, P =0.683）.Twenty-nine patients in the observation group and thirty patients in the control group once succeeded in the inserting of PICC .The difference was not significant （χ2 =1.017, P=0.313）.There were no statistical differences in catheter length , exposure length, operating time and catheter indwelling time （ P 〉0.05 ）.Conclusions It is feasible for the postoperative breast cancer patients to insert PICC lines in operative side upper limb .