CAJ | 학술논문

目的：探讨脐静脉置管技术在新生儿静脉营养支持中的临床应用价值。方法选择2011年6月至2014年1月入院至东华医院新生儿科，因不同疾病需要救治且需要静脉营养支持治疗的新生儿（早产儿54例，足月小样儿8例，足月儿合并重症不能进食者18例）80例，在出生＜24 h内行脐静脉置管术，建立静脉输液通道，并对其临床应用效果进行分析。结果80例患儿中77例置管成功，3例失败，置管成功率为96．3％。导管留置时间为7～21（7．5±2．2）d。其中4例使用1～3 d后导管堵塞，1例拆管剪线时误剪断导管，且回缩，后采取手术取出；3例发生导管相关感染，行血培养检查均为阴性，感染率为3．75％。留置导管过程中未发生腹腔感染、心律失常、新生儿坏死性肠炎、肝实质损伤、肝坏死、血栓、空气栓塞及脐出血等并发症。结论脐静脉置管术是重症新生儿静脉营养支持的一项重要技术，操作相对容易掌握，不良反应少，较经外周中心静脉置管术（PICC）时间早、成功率较高，出生后早期即可以安全使用，尤其是在低体质量、极低体质量患儿的应用中有广泛的前景。
목적：탐토제정맥치관기술재신생인정맥영양지지중적림상응용개치。방법선택2011년6월지2014년1월입원지동화의원신생인과，인불동질병수요구치차수요정맥영양지지치료적신생인（조산인54례，족월소양인8례，족월인합병중증불능진식자18례）80례，재출생＜24 h내행제정맥치관술，건립정맥수액통도，병대기림상응용효과진행분석。결과80례환인중77례치관성공，3례실패，치관성공솔위96．3％。도관류치시간위7～21（7．5±2．2）d。기중4례사용1～3 d후도관도새，1례탁관전선시오전단도관，차회축，후채취수술취출；3례발생도관상관감염，행혈배양검사균위음성，감염솔위3．75％。류치도관과정중미발생복강감염、심률실상、신생인배사성장염、간실질손상、간배사、혈전、공기전새급제출혈등병발증。결론제정맥치관술시중증신생인정맥영양지지적일항중요기술，조작상대용역장악，불량반응소，교경외주중심정맥치관술（PICC）시간조、성공솔교고，출생후조기즉가이안전사용，우기시재저체질량、겁저체질량환인적응용중유엄범적전경。
Objective To explore the clinical value of umbilical venous catheterization tech-nique in intravenous nutritional support in neonates.Methods Umbilical vein catheterization was performed within 24 hours after birth to establish intravenous access in 80 neonates who were ad-mitted to the Department of Neonatology of the Affiliated Dungwah Hospital of Sun Yat-sen Uni-versity from June 2011 to January 2014 for treatment and intravenous nutritional support (54 pre-mature infants,8 small for gestational age infants and 1 8 full-term infants with severe aphago-sis).The clinical efficacy was analyzed in all neonates.Results Among the 80 neonates,umbilical venous catheterization was successful in 77 (96.3%)and failed in 3.The average duration of in-dwelling catheters was (7.5±2.2)days (range,7 to 21 days).Catheter blockage occurred in 4 neonates 1-3 days after catheterization.The catheter was sheared off and became retracted during demolition but was removed with surgery in 1 neonate.Catheter-related infection occurred with negative blood culture result in 3 neonates (3.75%).No intra-abdominal infection,arrhythmia, necrotic enteritis, liver parenchymal cell inj ury, hepatonecrosis, thrombus, aeroembolism, omphalorrhagia and other complications were found during catheter indwelling.Conclusion Um-bilical venous catheterization is important for intravenous nutritional support in neonates.The technique is relatively easy to grasp and results in fewer adverse reactions.It can be performedearlier and produce higher success rate than the perocutaneous-inserted central venous catheter (PICC).Therefore,umbilical venous catheterization should be widely used for intravenous nutri-tional support,especially in low and extremely low birth weight infants.