三种扩皮送鞘法在肿瘤患者PICC置管中的应用效果观察

目的 探讨三种扩皮送鞘法在超声引导下改良塞丁格技术PICC置管中的应用效果，为临床操作提供参考。方法 将384例肿瘤科行PICC置管患者随机分为A、B、C三组，各128例。A组采用微插管鞘中的扩张器与传统穿刺针的外鞘组装后直接扩张穿刺点后送鞘的钝性分离法；B组采用扩张器与导管鞘组件扩张穿刺点后送鞘的钝性分离法；C组采用扩皮刀扩张穿刺点后推进血管鞘的方法。比较三组患者一次性送鞘成功率、置管后24 h穿刺点渗血情况及置管术中疼痛评分。结果 A组和C组一次性送鞘成功率100%，B组一次性送鞘成功率95.31%。三组穿刺点渗血情况、局部渗液发生率比较，差异有统计学意义（均P<0.01），A组和B组显著低于C组。A组和B组术中疼痛评分低于C组。结论 采用微插管鞘中的扩张器与传统穿刺针的外鞘组装后直接扩张穿刺点后送鞘的钝性分离法行PICC置管，不仅一次性送鞘成功率高，且患者置管术中疼痛及术后穿刺点局部渗血渗液等并发症发生率较低。

The effect of application of three skin-expansion methods to cancer patients for advancement of introducer sheath in PICC insertion

Objective To explore the effect of three skin-expansion methods applied to cancer patients for advancement of sheath in PICC insertion under modified Seldinger technique. Methods A total of 384 cancer patients to receive PICC insertion were selected and randomly divided into 3 groups,128 cases in each group. In group A, the PICC introducer sheath was inserted by blunt separation approach (the soft-tissue dilator and the outer sheath of traditional puncture needle were assembled prior to sheath insertion). In group B, the PICC introducer sheath was inserted by blunt separation which was performed with the soft-tissue dilator and the introducer sheath components. In group C, the PICC introducer sheath was inserted by expanding the skin with an expanding knife. One-time success rate of PICC introducer sheath insertion, incidence rates of blood oozing and exudate at the puncture site 24 h into catheterization as well as Visual Analogue Score (VAS) for pain during catheter insertion were compared among the three groups. Results One-time success rate of PICC introducer sheath insertion in group A and group C were both 100%, versus 95.31% in group B. The incidence rates of blood oozing and exudate at the puncture site 24 h into catheterization had significant differences among the 3 groups (P<0.01 for both), with group A and group B significantly lower than group C. Pain scores during catheter insertion in group A and group B were lower than group C. Conclusion The method of PICC introducer sheath insertion by blunt separation approach after assembling the soft-tissue dilator and the outer sheath of traditional puncture needle not only improves one-time success rate of sheath insertion, but also reduce the rate of blood oozing of and exudate at the puncture site and pain levels during catheterization.