肿瘤患者锁骨下静脉穿刺置管术常见合并症的预防及处置

目的探讨肿瘤患者锁骨下静脉穿刺置管术常见合并症的预防及处理方法。方法对2001年8月至2008年7月收集的中国中医科学院广安门医院1485例进行锁骨下静脉穿刺置管术的恶性肿瘤患者进行回顾性分析,研究其产生的相关合并症及其处理对策。结果1485例患者中有98例发生合并症,发生率为6.59%,其中穿刺置管过程中误入动脉22例(1.48%),误入颈内静脉4例(0.27%),气胸2例(0.13%),心律失常3例(0.20%);出血1例(0.06%);置管后导管相关感染36例(2.42%),导管堵塞25例(1.68%),导管脱出5例(0.34%)。结论锁骨下静脉穿刺置管术虽然存在着一定的合并症,但随着操作者临床经验的积累,可以预防和减少合并症的发生,锁骨下静脉穿刺置管术是肿瘤患者较为安全的静脉穿刺方法。

Prevention and Handling Strategies on Common Complications of Subclavian Central Venous Catheters in Patients with Tumor

Objective To explore prevention and handling strategies on common complications of subclavian central venous catheters (CVC) in patients with tumor. Methods One thousand four hundred and eighty-five patients with malignant tumor undergone subclavian CVC in our hospital from August 2001 to July 2008 were retrospectively analyzed to study correlative complications and handling strategies. Results Complications occurred in 98 cases (6.59 %), including 22 cases of puncturing the artery by mistake(1.48%), four cases of puncturing the internal jugular vein by mistake(0.27%), two cases of pneumothorax(0.13%), three cases of arrhythmia(0.20%), one case of local hematoma(0.06%), thirty-six cases of infection after catheterization(2.42%), twenty-five cases of catheter obstruction(1.68%), five cases of catheter prolapse(0.34%). Conclusion Although subclavian CVC has certain risk, the complications can be prevented and reduced along with more accumulated clinical experience. Subclavian CVC is a safe method to carry out venipuncture for tumor patients.