CAJ | 학술논문

目的：探讨多次 PICC 置管对导管尖端位置的影响。方法对2014年5—10月北京市某三级甲等医院肿瘤科 PICC 置管患者的导管尖端位置进行分析。共收集381例有效病例，根据有无 PICC置管史分为有置管史组和无置管史组，其中把有置管史者再分为有同侧置管史（ B1组）和无同侧置管史（B0组）两组，比较各组间导管尖端位置。结果有置管史组的导管尖端最佳位置符合率（30.97%）低于无置管史组（52.66%），差异有统计学意义（χ2=17.565，P ＜0.01），有置管史组置入过浅的发生率（47.74%）高于无置管史组（35.40%），差异有统计学意义（χ2=5.817，P ＜0.05），有置管史组的导管尖端异位于锁骨下静脉的发生率高于无置管史组，差异有统计学意义（ P ＜0.05）。B1组导管尖端最佳位置符合率低于 B0组，导管尖端异位于锁骨下静脉发生率高于 B0组，差异有统计学意义（ P ＜0.05）。结论多次 PICC 置管降低导管尖端位置的准确性，影响 PICC 的安全使用及长期保留。应尽可能降低PICC 患者非计划性拔管的发生率。若要进行再次的 PICC 置管，在无置管禁忌证的情况下，应优先选择对侧肢体，以促进 PICC 导管的安全使用。
목적：탐토다차 PICC 치관대도관첨단위치적영향。방법대2014년5—10월북경시모삼급갑등의원종류과 PICC 치관환자적도관첨단위치진행분석。공수집381례유효병례，근거유무 PICC치관사분위유치관사조화무치관사조，기중파유치관사자재분위유동측치관사（ B1조）화무동측치관사（B0조）량조，비교각조간도관첨단위치。결과유치관사조적도관첨단최가위치부합솔（30.97%）저우무치관사조（52.66%），차이유통계학의의（χ2=17.565，P ＜0.01），유치관사조치입과천적발생솔（47.74%）고우무치관사조（35.40%），차이유통계학의의（χ2=5.817，P ＜0.05），유치관사조적도관첨단이위우쇄골하정맥적발생솔고우무치관사조，차이유통계학의의（ P ＜0.05）。B1조도관첨단최가위치부합솔저우 B0조，도관첨단이위우쇄골하정맥발생솔고우 B0조，차이유통계학의의（ P ＜0.05）。결론다차 PICC 치관강저도관첨단위치적준학성，영향 PICC 적안전사용급장기보류。응진가능강저PICC 환자비계화성발관적발생솔。약요진행재차적 PICC 치관，재무치관금기증적정황하，응우선선택대측지체，이촉진 PICC 도관적안전사용。
Objective To explore the influence of repeatedly PICC catheterized on catheter tip position. Methods We analyzed the catheter tip position of patients who located PICC in one level three class-A hospital in Beijing from May to October in 2014. A total of 381 effective medical records were collected and divided into having the history of catheterization group and having no history of catheterization group depending on patients whether catheterized before. The patients having the history catheterization were divided into ipsilateral catheter group(B1 group)and no ipsilateral catheter group(B0 group),the catheter tip position was compared. Results The best catheter tip position for patients having the history of catheterization was 30. 79% , which was lower than patients having no history group of 52. 66%(χ2 = 17. 565,P < 0. 01),and the patients of having catheterization history group had the incidence rate of shallow catheterization(47. 74% )higher than 35. 40% in the no catheterization history group(χ2 = 5. 817,P < 0. 05). The patients of having catheterization history group happened the incidence of catheter tip position acquired dystopia of venae subclavia higher than patients having no catheterization history group(P < 0. 05). The best catheter tip position had lower rate in the B1 group comparing with B0 group,but the patients acquired dystopia of venae subclavia in the B1 group was lower than the patients in the B0 group(P < 0. 05). Conclusions Multiple PICC catheterization reduces the accuracy of catheter tip position,and impacts the safety and reservation of PICC. We should minimize the non-planned extubation incidences. If patients require re-catheterizaiton,we should select the opposite limbs to catheterize without catheterizaiton contraindication to ensure the safe of PICC catheterization.