比较超声引导下与盲穿使用改良Seldinger技术置入PICC导管的临床研究

目的观察并比较超声引导下和盲穿采用改良Seldinger技术穿刺贵要静脉置PICC导管,在乳腺癌患者(单侧)术后化疗中的效果与差异。方法采用随机对照试验,将140例单侧乳腺癌术后化疗患者分为观察组和对照组,观察组70例,对照组70例。观察组在超声引导下采用改良Seldinger技术穿刺贵要静脉后置PICC导管,对照组使用改良Seldinger技术在肘上肱二头肌腱内侧盲穿贵要静脉置入PICC导管,由PICC置管专科护士进行为期两周的临床跟踪观察,置管后第1周每日观察,第2周仅第14天观察。主要观察内容:置入PICC管后的导管头端位置、渗血、皮下瘀血、静脉血栓、机械性静脉炎以及导管相关性感染的发生情况,将结果归纳分类并记录在自制的表格中。结果观察组穿刺成功68例,成功率97.14%;对照组穿刺成功59例,成功率84.28%,两组比较差异有显著意义(P<0.05);机械性静脉炎第7天与第14天的观察结果,两组比较差异有显著意义(P<0.05);皮下淤血第7天的观察结果显示,两组比较差异有显著意义(P<0.05);渗血、静脉血栓、导管相关性感染情况两周内观察结果,两组差异无显著意义(P>0.05)。结论超声引导下使用改良Seldinger技术穿刺贵要静脉可减少各种并发症的发生。

Clinical study of the comparison of ultrasound-guided and blind wear modified Seldinger technique for placement of PICC

Objective To investigate and compare the clinical effects on planting PICC catheter through basilic vein for patients(undergoing postoperative chemotherapy) with unilateral breast cancer by ultrasound-guided and blind use of improved Seldinger technique. Method 140 postoperative chemotherapy patients with unilateral breast cancer were randomly divided into observation group and control group(70 for each group).The observation group were planted PICC catheter through basilic vein under the guidance of ultrasound,while the control group were blindly planted at medial part of biceps tendon.The clinical observation lasting for two weeks by each nurse on patients with PICC catheter was carried daily during the first week and only at the 14th day during the second week.The following items were observes and recorded in self-made table,such as tip position of catheter after being planted,bleeding,skin congestion,mechanical phlebitis,venous thrombosis,catheter-related infection cases. Result The puncture success rate for observation group and control group were 97.14%(68 cases) and 84.28%(59 cases) with significant difference(P<0.05);There was a significant difference between two groups on mechanical phlebitis at both 7th day and 14th day(P<0.05);The observation of skin congestion at 7th day showed a difference between two groups(P<0.05);No significant differences were found on other items during the two-week observation(P>0.05). Conclusion Ultrasound guided planting PICC catheter through basilic vein with improved seldinger technique can facilitate the reducing of relevant complications.