中华临床营养杂志
中華臨床營養雜誌
중화림상영양잡지
CHINESE JOURNAL OF CLINICAL NUTRITION
2010年
2期
87-90
,共4页
冯毕龙%谭晓辉%童莉%王蓓%周素军
馮畢龍%譚曉輝%童莉%王蓓%週素軍
풍필룡%담효휘%동리%왕배%주소군
经外周静脉置入中心静脉导管%右侧上肢%左侧上肢%结局%前瞻性随机对照研究
經外週靜脈置入中心靜脈導管%右側上肢%左側上肢%結跼%前瞻性隨機對照研究
경외주정맥치입중심정맥도관%우측상지%좌측상지%결국%전첨성수궤대조연구
Peripheral inserted central catheterizations%Right upper limb%Left upper limb%Outcome%Prospective,randomized controlled study
目的 比较经左、右侧上肢床旁行经外周静脉置入中心静脉导管(PICC)对置管结局的影响.方法 2007年5月至2008年5月在武汉大学中南医院行PICC的患者458例,按随机表分为经左侧置入组(n=230)和右侧置入组(n=228)两组,于置管后即刻行胸部X线检查确认导管头端位置,并随访至导管停止使用时为止.结果 右侧置入组出现送管困难的比率明显低于左侧置入组(14.9%比24.8%,P=0.003),导管头端大于40°成角的比率也明显低于左侧置入组(2.2%比23.4%,P=0.000).两组患者导管头端位于中心静脉部位的到位率差异无统计学意义(54.4%比53.0%,P=0.538),右侧置入组头端位于上腔静脉近心段的比率明显高于左侧置入组(21.0%比6.6%,P=0.001);右侧置入组导管头端异位于头臂静脉的比率明兄低于左侧置入组(48.1%比66.7%,P=0.008),异位于颈内静脉(P=0.859)和锁骨下静脉(P=0.696)的比率与左侧置入组差异无统计学意义.两组患者在导管留置时间(P=0.617)、穿刺血管局部静脉炎发生率(P=0.561)、导管堵塞率(P=0.774)及导管相关感染率(P=0.854)方面差异无统计学意义,右侧置入组的上肢肿胀发生率明显低于左侧置入组(4.4%比8.3%,P=0.043).结论 经右侧上肢置入PICC的效果优于经左侧上肢,建议临床中置入PICC时优先选择经右侧上肢置管.
目的 比較經左、右側上肢床徬行經外週靜脈置入中心靜脈導管(PICC)對置管結跼的影響.方法 2007年5月至2008年5月在武漢大學中南醫院行PICC的患者458例,按隨機錶分為經左側置入組(n=230)和右側置入組(n=228)兩組,于置管後即刻行胸部X線檢查確認導管頭耑位置,併隨訪至導管停止使用時為止.結果 右側置入組齣現送管睏難的比率明顯低于左側置入組(14.9%比24.8%,P=0.003),導管頭耑大于40°成角的比率也明顯低于左側置入組(2.2%比23.4%,P=0.000).兩組患者導管頭耑位于中心靜脈部位的到位率差異無統計學意義(54.4%比53.0%,P=0.538),右側置入組頭耑位于上腔靜脈近心段的比率明顯高于左側置入組(21.0%比6.6%,P=0.001);右側置入組導管頭耑異位于頭臂靜脈的比率明兄低于左側置入組(48.1%比66.7%,P=0.008),異位于頸內靜脈(P=0.859)和鎖骨下靜脈(P=0.696)的比率與左側置入組差異無統計學意義.兩組患者在導管留置時間(P=0.617)、穿刺血管跼部靜脈炎髮生率(P=0.561)、導管堵塞率(P=0.774)及導管相關感染率(P=0.854)方麵差異無統計學意義,右側置入組的上肢腫脹髮生率明顯低于左側置入組(4.4%比8.3%,P=0.043).結論 經右側上肢置入PICC的效果優于經左側上肢,建議臨床中置入PICC時優先選擇經右側上肢置管.
목적 비교경좌、우측상지상방행경외주정맥치입중심정맥도관(PICC)대치관결국적영향.방법 2007년5월지2008년5월재무한대학중남의원행PICC적환자458례,안수궤표분위경좌측치입조(n=230)화우측치입조(n=228)량조,우치관후즉각행흉부X선검사학인도관두단위치,병수방지도관정지사용시위지.결과 우측치입조출현송관곤난적비솔명현저우좌측치입조(14.9%비24.8%,P=0.003),도관두단대우40°성각적비솔야명현저우좌측치입조(2.2%비23.4%,P=0.000).량조환자도관두단위우중심정맥부위적도위솔차이무통계학의의(54.4%비53.0%,P=0.538),우측치입조두단위우상강정맥근심단적비솔명현고우좌측치입조(21.0%비6.6%,P=0.001);우측치입조도관두단이위우두비정맥적비솔명형저우좌측치입조(48.1%비66.7%,P=0.008),이위우경내정맥(P=0.859)화쇄골하정맥(P=0.696)적비솔여좌측치입조차이무통계학의의.량조환자재도관류치시간(P=0.617)、천자혈관국부정맥염발생솔(P=0.561)、도관도새솔(P=0.774)급도관상관감염솔(P=0.854)방면차이무통계학의의,우측치입조적상지종창발생솔명현저우좌측치입조(4.4%비8.3%,P=0.043).결론 경우측상지치입PICC적효과우우경좌측상지,건의림상중치입PICC시우선선택경우측상지치관.
Objective To compare the effectiveness and safety of central venous catheters inserted from the left side and right side during peripheral inserted central catheterizations (PICC). Methods Totally 458 adult patients undergoing PICC between May 2007 and May 2008 were enrolled in this study and divided randomly into right-sided group (n = 228)and left-slded group (n = 230). Chest X-ray was performed immediately after catheterization to identify the initial tip locations. Other parameters were evaluated during follow-up. Results The rate of difficult insertion was significantly lower in right-sided group than in left-sided group (14.9% vs 24. 8% , P =0.003). The rate of tip projection angle ＞40°was also significantly lower in right-sided group (2.2% vs 23.4% ,P = 0. 000). The rate of tips reaching the central veins was not significantly different between two groups (54.4%vs 53.0% , P = 0. 538). Compared with right-sided catheters, the tip positions in the left-sided group was significantly less frequently located in the inferior segment of superior vena cave in the central tip locations (6. 6% vs 21.0% , P =0. 001)and more commonly positioned in the nominate vein in non-central tip locations (66. 7% vs 48.1% , P = 0. 008). In addition, the catheter detaining time (P = 0. 617), incidence of local phlebitis after puncture (P = 0. 561), catheter obstruction rate (P = 0. 774), and catheter-related infection rate (P = 0. 854)showed no significant differences between two groups. The incidence of swollen limb was significantly lower inright-sided group than in left-sided group (4. 4% vs 8.3%, P = 0. 043). Conclusions Right-sided catheters provide better outcomes than left-sided catheters. PICC through the right elbow veins should be preferred in clinical practices.
