CAJ | 학술논문

目的：探讨65岁以上老年食管癌患者在置入PICC导管过程中，采取措施干预静脉血栓的形成，从而降低上腔静脉系血栓发生的风险。方法 PICC置管专科护士筛选65岁以上老年食管癌患者入组，采用随机对照试验，将340例食管癌化疗患者分为观察组和对照组，观察组170例，对照组170例。观察组采用超声引导下改良seldinger技术在肘上穿刺贵要静脉置入PICC导管，置管后科学指导患者运动方式，局部热敷贵要静脉体表投影解剖位置，连续7天，遵医嘱皮下注射低分子肝素钠5000 IU每天1次，连续14天，随访12周。对照组采用盲穿贵要静脉置入PICC导管，置管后指导患者运动方式，连续7天，随访12周。随访以彩色多普勒超声下见穿刺静脉血管腔内实性回声作为确诊静脉血栓的标准，记录静脉血栓发生相关情况。结果观察组穿刺成功165例，成功率97.14%，其中7例发生腋静脉血栓，对照组穿刺成功143例，成功率84.28%，其中16例发生腋静脉及颈内静脉血栓。两组比较差异有显著意义（P=0.021）。结论在置入PICC导管过程中，采取干预措施，可以降低上腔静脉系血栓发生的风险。
목적：탐토65세이상노년식관암환자재치입PICC도관과정중，채취조시간예정맥혈전적형성，종이강저상강정맥계혈전발생적풍험。방법 PICC치관전과호사사선65세이상노년식관암환자입조，채용수궤대조시험，장340례식관암화료환자분위관찰조화대조조，관찰조170례，대조조170례。관찰조채용초성인도하개량seldinger기술재주상천자귀요정맥치입PICC도관，치관후과학지도환자운동방식，국부열부귀요정맥체표투영해부위치，련속7천，준의촉피하주사저분자간소납5000 IU매천1차，련속14천，수방12주。대조조채용맹천귀요정맥치입PICC도관，치관후지도환자운동방식，련속7천，수방12주。수방이채색다보륵초성하견천자정맥혈관강내실성회성작위학진정맥혈전적표준，기록정맥혈전발생상관정황。결과관찰조천자성공165례，성공솔97.14%，기중7례발생액정맥혈전，대조조천자성공143례，성공솔84.28%，기중16례발생액정맥급경내정맥혈전。량조비교차이유현저의의（P=0.021）。결론재치입PICC도관과정중，채취간예조시，가이강저상강정맥계혈전발생적풍험。
Objective To explore the risk of venous thrombsis in superior vena cava in elder (>65 years old) patients with esophageal cancer after nursing intervention in the process of PICC. Methods Three hundred and forty elder patients with esophageal cancer divided into observation group and control group randomly (n=170 for each group). The cases in observation group were planted PICC catheter through basilic vein under the guidance of ultrasound with seldinger technique, guided movement by nurses, a local hot compress on the shadow of basilic vein for 7 d, injected subcutaneously 5 000 IU low molecular weight heparin sodium once a day for two weeks and followed up 12 w. While cases in control group were blindly planted at medial part of biceps tendon, guided move-ment by nurses and followed up 12 w. Venous thrombus was diagnosed by ultrasound and recorded. Results Seven of one hundred and sixty-five cases(97.14%) planted successfully PICC in observation group developed axil-lary vein thrombsis, while 16 of 143 cases (84.28%) in control group developed axillary vein and internal jugular vein thrombsis. The difference was significant between the two groups (P<0.05). Conclusion Nursing interven-tion in the process of PICC could decrease risk of venous thrombsis in superior vena cava in elder patients with esophageal cancer.