超声引导下改良Seldinger技术行PICC置管与传统穿刺置管应用效果比较

王璇

[摘要] 目的 比较超声引导下改良Seldinger技术行PICC置管与传统穿刺置管的应用效果。 方法 选择沈阳医学院附属中心医院2010年6月～2013年12月门诊或住院需要进行PICC置管的患者280例，随机分为两组，各140例。研究组患者采用超声引导下改良Seldinger技术经上臂行PICC置管，对照组患者采用传统穿刺方法进行PICC置管。观察两组患者一次穿刺成功率、一次置管成功率、总置管成功率，观察贵要静脉使用情况、置管后导管末端位置及相关并发症情况。 结果 研究组一次穿刺成功率、一次置管成功率及总置管成功率明显高于对照组（99.3%、97.8%、99.3%比80.0%、77.8%、88.6%），组间比较差异均有统计学意义（χ2=6.395、6.843、4.283，P < 0.05）。两组穿刺静脉及导管末端位置比较差异有统计学意义（χ2=7.209、4.375，P < 0.05）。研究组导管留置时间长于对照组[（162±20）d比（124±17）d]，差异有统计学意义（t=5.794，P < 0.05）。研究组静脉炎、静脉血栓、周围组织损伤发生率明显低于对照组（P < 0.05），两组穿刺点渗血、导管相关感染发生率差异无统计学意义（P > 0.05）。 结论 超声引导下改良Seldinger技术行PICC置管可有效提高穿刺及置管成功率，且导管异位及穿刺相关并发症发生率明显降低，安全性较高，值得推广应用。

[关键词] 超声引导；改良Seldinger技术；经外周静脉置入中心静脉导管；静脉穿刺

[中图分类号] R473 [文献标识码] A [文章编号] 1673-7210（2014）09（a）-0050-05

[Abstract] Objective To compare the effect of ultrasound-guided peripherally inserted central catheter （PICC） under modified Seldinger technique and traditional PICC. Methods 280 cases of outpatients and inpatients required PICC in Central Hospital Affiliated to Shenyang Medical College from June 2010 to December 2013 were randomly divided into two groups， each of 140 cases. Patients of study group were given ultrasound-guided PICC on upper arm under modified Seldinger technique， and patients in control group were given traditional PICC. One time puncture success rate， one time catheter success rate， total catheter success rate， the usage condition of basilic vein， tip position of catheter， and related complications of two groups were observed and compared. Results The one time puncture success rate， one time catheter success rate， total catheter success rate of study group were significantly higher than those of control group （99.3%， 97.8%， 99.3% vs 80.0%， 77.8%， 88.6%）， the differences between the two groups were statistically significant （χ2=6.395， 6.843，4.283， P < 0.05）. The usage condition of puncture veins and tip position of catheter were compared between the two groups， the differences were statistically significant （χ2=7.209， 4.375， P < 0.05）. Catheter indwelling time of study group was longer than the control group [（162±20） d vs （124±17） d] （t=5.794， P < 0.05）. The occurrence rates of phlebitis， venous thrombosis， peripheral tissue damage of study group were significantly lower than those of the control group （P < 0.05）， occurrence rates of puncture point bleeding， catheter-related infection between the two groups had no significantly different （P > 0.05）. Conclusion Ultrasound-guided PICC under modified Seldinger technique can effectively improve the success rate of puncture and catheterization， reduce the incidence of catheter-related complications and ectopic catheter， had high security， which should be widely applied.endprint