皮下隧道股静脉穿刺置管用于重型颅脑损伤患者长期保持静脉通道的探讨

目的 :总结重型颅脑损伤患者长期静脉输液药物治疗、静脉高营养预防导管相关性感染的经验。方法 :随机将 137例重型颅脑损伤所致昏迷患者分为两组 ,实验组 (6 9例 )用经皮下隧道股静脉穿刺置管法建立静脉通道 ;对照组 (6 8例 )用传统股静脉穿刺置管法。两组均经此通道常规输液及补充静脉高营养素。穿刺点每周换药 2次 ,细菌培养 1次 ,发热患者行血培养 ,拔管时取导管尖端培养。观察导管阻塞、脱落、导管相关性感染等并发症以及留管时间等。结果 :实验组留管时间长于对照组 ,导管脱落及相关性感染、穿刺点感染等并发症的发生少于对照组 ,差异有显著性 (P <0 0 5或 0 0 1)。导管阻塞的发生率两组无差异 (P >0 0 5 )。结论 :经皮下隧道股静脉穿刺置管能有效降低导管相关性感染的发生率 ,延长留管时间 ,适合需长时间保留静脉通道的患者

A contrast investigation about subcutaneous tunnel of femoral vein puncture used for heavy craniocerebral injury patients for the transfuse passage long term keeping

Objective:To summarize the experience of giving the liquid drugs and high nutritious to the patients with heavy craniocerebral trauma through long time vena transfusion,and to research for available methods of defending relativity infection of vessel.Method:137 cases patients with coma because of heavy craniocerebral trauma were divided into two groups randomly,the research group(n=69) were set up vein routeway through subcutaneous tunnel of femoral vein puncture,but the control group(n=68) were set up vein routeway through traditional femoral vein puncture,and the puncture place was bartered drug and done germiculture one time every week.The blood and catheter were done germiculture if the patients got fever or drew vein catheter.Two groups were supplied high nutriment through vein routeway.The complication of catheter block,shedding and relative infection and the time of remaining the catheter was observed.Result:The remaining catheter time of research group was longer than that of the control group,and the complication of catheter shedding,relative infection and the puncture place infection of research group were less than that of the control group,and the difference was very remarkable(P<0.05 or 0.01).But incidence rate of catheter blocking of two group was of no difference (P>0.05).Conclusion:The method can efficiently reduce the incidence rate of catheter relative infection and extend the remaining catheter time that is set up vein routeway through subcutaneous tunnel of femoral vein puncture.So it adapts to the patients for the transfuse passage long term keeping.