皮下埋藏式中心静脉导管应用于肿瘤化疗患者的临床效果

目的 探讨皮下埋藏式中心静脉导管应用于肿瘤化疗患者的安全性和有效性,以寻找一种合理的可长期留置的中央静脉导管给药方式.方法 120例肿瘤根治术后患者,需长期全身化疗(9个月至2年).分3组:40例患者采用经皮外周插入式中央导管(PICC)化疗(PICC组),40例患者采用反复中心静脉穿刺置管(CVC)行化疗(CVC组:颈内静脉组和锁骨下静脉组各20例),40例患者采用皮下埋藏式中心静脉导管(PORT)行化疗(PORT组:颈内静脉组和锁骨下静脉组各20例).比较3组患者导管植入并发症及化疗期间生活质量满意度评分.结果 PICC组的近期并发症主要表现为置入导管位置异常;中心静脉穿刺的近期并发症主要表现为血肿(颈内静脉)和气胸(锁骨下静脉).PICC组导管阻塞及血栓形成的发生率明显高于另两组(均P<0.05).发生局部组织感染和全身感染的机会PIEC组和CVC组明显高于PORT组(均P<0.05).PORT组患者化疗期间生活质量满意度评分明显高于另两组(均P<0.05).结论 经皮下泵中心静脉留置技术在肿瘤化疗患者应用中可减少并发症,提高患者生活质量.

Safety and effectiveness of central vein catheters indwelling with subcutaneous port in patients undergoing chemotherapy

Objective To investigate the safety and effectiveness of 3 methods of central vein catheters indwelling in cancer patients undergoing chemotherapy. Methods 120 cancer patients undergoing long-term chemotherapy(9 months-2 years)were divided into 3 equal groups to be treated via peripherally inserted central catheter(PICC), untunneled central venous catheter (CVC) by repeat venipuncture (20 through jugular vein and 20 through subclavian vein), and implanted subinfuse-port ( PORT, 20 through jugular vein and 20 through subclavian vein). The complications of implantation and quality of life were compared. Results The early complication of the PICC group was malposition of the tip of catheters; and the early complications of the CVC group included hematoma in the jugular vein subgroup and pneumothorax in the subclavian vein subgroup. The incidence rates of catheter obstruction and thrombosis of the PORT group were significantly higher than those of the other two groups ( all P< 0.05 ). The incidence rate of infection (regional and systemic) of the PORT group was significantly lower than those of the other two groups (both P<0. 05). The satisfaction score during chemotherapy of the PORT group was (5.6±1.6), significantly higher than those of the PICC and CVC groups (3.3±0.8 ) and ( 3.9±0.6) respectively, both P< 0. 05 ], and the satisfaction score between chemotherapy courses of the PORT group was (5.7± 0.7), significantly higher than those of the PICC and CVC groups (4.5±0.8 ) and (4.8 ± 1.2 ) respectively, both P< 0.05 ]. Conchusion The technology of central vein catheter indwelling with subcutaneous port in patients undergoing chemotherapy is effective and safe.