CAJ | 학술논문

目的：探讨超声引导下辅助改良塞丁格技术PICC穿刺局部麻醉时机的选择，为临床制定统一操作标准提供理论依据。方法将128例行PICC置管术患者按随机数字表法分为前麻醉组和后麻醉组各64例。前麻醉组置管时，穿刺前在穿刺点注射2％利多卡因0．2 ml做局部麻醉；后麻醉组置管时，在导丝成功植入后扩皮刀扩皮前在穿刺点注射2％利多卡因0．2 ml做局部麻醉。评估两组患者在穿刺过程中置管肢体的疼痛评分和穿刺次数。结果前麻醉组患者疼痛评分为（1．64±1．58）分，后麻醉组为（1．64±1．21）分，两组比较差异无统计学意义（t＝0．00，P＞0．05），但前麻醉组穿刺次数（1．59±1．35）次，明显多于后麻醉组（1．18±0．50）次，两组比较差异有统计学意义（t＝2．20，P＜0．05）。穿刺前麻醉组，局部麻醉点到实际穿刺点距离与疼痛评分呈正相关（r＝0．319，P＜0．05）。结论穿刺前局部麻醉与放入导丝后局部麻醉所致置管肢体疼痛无差异，但放入导丝后局部麻醉最终穿刺次数少于穿刺前麻醉，可提高穿刺成功率。
목적：탐토초성인도하보조개량새정격기술PICC천자국부마취시궤적선택，위림상제정통일조작표준제공이론의거。방법장128례행PICC치관술환자안수궤수자표법분위전마취조화후마취조각64례。전마취조치관시，천자전재천자점주사2％리다잡인0．2 ml주국부마취；후마취조치관시，재도사성공식입후확피도확피전재천자점주사2％리다잡인0．2 ml주국부마취。평고량조환자재천자과정중치관지체적동통평분화천자차수。결과전마취조환자동통평분위（1．64±1．58）분，후마취조위（1．64±1．21）분，량조비교차이무통계학의의（t＝0．00，P＞0．05），단전마취조천자차수（1．59±1．35）차，명현다우후마취조（1．18±0．50）차，량조비교차이유통계학의의（t＝2．20，P＜0．05）。천자전마취조，국부마취점도실제천자점거리여동통평분정정상관（r＝0．319，P＜0．05）。결론천자전국부마취여방입도사후국부마취소치치관지체동통무차이，단방입도사후국부마취최종천자차수소우천자전마취，가제고천자성공솔。
Objective To explore the timing of local anesthesia in ultrasound-guided modified Seldinger technique PICC puncture, so as to provide theoretical basis for formulating unified operating standards in clinic. Methods Totals of 128 patients with PICC after operation were randomly divided into pre-anesthesia group and post-anesthesia group (64 cases in each group).In pre-anesthesia group, 0.2 ml 2%lidocaine was injected in the puncture point before puncturing; in post-anesthesia group, 0.2 ml 2% lidocaine was injected after puncturing.Body pain score in the process of puncturing and times of puncturing were compared between the two groups.Results The body pain score in pre-anesthesia group was (1.64 ±1.58),and (1.64 ±1.21)in post-anesthesia group, the difference was not statistically significant (t=0.00,P>0.05).The times of puncturing in pre-anesthesia group was (1.59 ±1.35), which higher than (1.18 ±0.50) in post-anesthesia group, and the difference was statistically significant (t=2.20,P<0.05).In pre-anesthesia group, the distance from local anesthesia point to the actual piercing point was positively related to pain score (r =0.319,P <0.05). Conclusions The pain were no different caused by local anesthesia before and after piercing, but less piercing times in condition of anesthesia after putting thread in, which can improve the success rate of puncture.