现代医药卫生
現代醫藥衛生
현대의약위생
MODERN MEDICINE HEALTH
2014年
21期
3220-3222
,共3页
导管,留置%导管插入术,中心静脉%颈静脉%导管异位%复位%支撑导丝
導管,留置%導管插入術,中心靜脈%頸靜脈%導管異位%複位%支撐導絲
도관,류치%도관삽입술,중심정맥%경정맥%도관이위%복위%지탱도사
Catheters,indwelling%Catheterization,central venous%Jugular veins%Catheter misplacement%Re-location%Guidewire
目的：探讨经外周静脉置入中心静脉导管（PICC）时延迟撤离支撑导丝对颈内静脉导管异位复位成功率的影响。方法将2013年1月至2014年1月行PICC的316例患者随机分为对照组和观察组各158例。对照组在导管置入预测长度后撤离支撑导丝，再用超声探头探查颈静脉，确认导管无异位后修剪导管并连接正压接头，如发现导管异位立即在无菌条件下行复位；观察组在导管置入至预测长度后立即用超声探头探查颈静脉，如导管无异位再撤离支撑导丝，修剪导管并连接正压接头，如发现导管异位及时在支撑导丝作用下行复位。对比两组患者在置管过程中颈内静脉导管异位的发生率、复位成功率以及平均复位时间的差异。结果观察组发生导管异位30例，其中颈内静脉导管异位29例；对照组发生导管异位32例，其中颈内静脉导管异位27例。观察组颈内静脉导管异位发生率（18.35%）与对照组（17.09%）比较，差异无统计学意义（P＞0.05）；但复位成功率（96.55%，28/29）高于对照组（77.78%，21/27），平均复位时间[（5.70±1.22）min]短于对照组[（8.90±2.53）min]，差异均有统计学意义（χ2=4.51，t=6.10，P＜0.05）。结论在超声引导下应用赛丁格技术行PICC术中，导管送至预测长度后常规探查颈静脉，排除颈内静脉导管异位后撤除支撑导丝，有利于颈内静脉导管异位的复位。
目的：探討經外週靜脈置入中心靜脈導管（PICC）時延遲撤離支撐導絲對頸內靜脈導管異位複位成功率的影響。方法將2013年1月至2014年1月行PICC的316例患者隨機分為對照組和觀察組各158例。對照組在導管置入預測長度後撤離支撐導絲，再用超聲探頭探查頸靜脈，確認導管無異位後脩剪導管併連接正壓接頭，如髮現導管異位立即在無菌條件下行複位；觀察組在導管置入至預測長度後立即用超聲探頭探查頸靜脈，如導管無異位再撤離支撐導絲，脩剪導管併連接正壓接頭，如髮現導管異位及時在支撐導絲作用下行複位。對比兩組患者在置管過程中頸內靜脈導管異位的髮生率、複位成功率以及平均複位時間的差異。結果觀察組髮生導管異位30例，其中頸內靜脈導管異位29例；對照組髮生導管異位32例，其中頸內靜脈導管異位27例。觀察組頸內靜脈導管異位髮生率（18.35%）與對照組（17.09%）比較，差異無統計學意義（P＞0.05）；但複位成功率（96.55%，28/29）高于對照組（77.78%，21/27），平均複位時間[（5.70±1.22）min]短于對照組[（8.90±2.53）min]，差異均有統計學意義（χ2=4.51，t=6.10，P＜0.05）。結論在超聲引導下應用賽丁格技術行PICC術中，導管送至預測長度後常規探查頸靜脈，排除頸內靜脈導管異位後撤除支撐導絲，有利于頸內靜脈導管異位的複位。
목적：탐토경외주정맥치입중심정맥도관（PICC）시연지철리지탱도사대경내정맥도관이위복위성공솔적영향。방법장2013년1월지2014년1월행PICC적316례환자수궤분위대조조화관찰조각158례。대조조재도관치입예측장도후철리지탱도사，재용초성탐두탐사경정맥，학인도관무이위후수전도관병련접정압접두，여발현도관이위립즉재무균조건하행복위；관찰조재도관치입지예측장도후립즉용초성탐두탐사경정맥，여도관무이위재철리지탱도사，수전도관병련접정압접두，여발현도관이위급시재지탱도사작용하행복위。대비량조환자재치관과정중경내정맥도관이위적발생솔、복위성공솔이급평균복위시간적차이。결과관찰조발생도관이위30례，기중경내정맥도관이위29례；대조조발생도관이위32례，기중경내정맥도관이위27례。관찰조경내정맥도관이위발생솔（18.35%）여대조조（17.09%）비교，차이무통계학의의（P＞0.05）；단복위성공솔（96.55%，28/29）고우대조조（77.78%，21/27），평균복위시간[（5.70±1.22）min]단우대조조[（8.90±2.53）min]，차이균유통계학의의（χ2=4.51，t=6.10，P＜0.05）。결론재초성인도하응용새정격기술행PICC술중，도관송지예측장도후상규탐사경정맥，배제경내정맥도관이위후철제지탱도사，유리우경내정맥도관이위적복위。
Objective To investigate the effect of delaying removal of bracing guide wire on successful rate of catheter misplacement restoration in the process of peripherally inserted central catheter(PICC). Methods A total of 316 patients,who were with PICC from January 2013 to January 2014,were randomized into control group and observation group,158 cases in each group. After arriving prediction length,the bracing guide wire was withdrew in the control group,the ultrasonic probe was used to detect jugularvein to trim the catheter and connect bonding head of positive pressure after confirming the catheter was not mis-placed,but if the catheter was misplaced,it should be restored in sterile conditions as soon as possible. After arriving prediction length,the jugularvein was ultrasonic detected by probe immediately in the observation group,the bracing guide wire was with-drew to trim the catheter and connect the positive bonding head after confirming the catheter was not misplaced ,but if the catheter was misplaced,it should be restored under bracing guide wire timely. The incidence rate,restoration rate and mean time-consum-ing of catheter misplacement in jugular vein during catheterization of the two groups were compared. Results The incidence rate of catheter misplacement in jugular vein between the observation group(18.35%) and control group(17.09%) had no statistically significant difference(P>0.05),but the difference on successful rate and between the observation group(96.55%,28/29) and the control group(77.78%,21/27) mean time[(5.70±1.22)min,(8.90±2.53)min] had statistical significance(χ2=4.51,t=6.10,P<0.05). Conclusion In the application of modified Seldinge technique(MST) under the guidance of ultrasound in PICC,convention de-tection after the catheter arriving prediction length and removal of bracing guide wire after excluding phlebectopia are beneficial to the restoration of catheter misplacement in jugular vein.
