静脉造影引导及连续X线透视辅助下PICC置管术的可行性研究
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摘要
目的:探讨静脉造影引导及连续X线透视辅助下外周中心静脉置管术(PICC)的应用价值及安全性。方法:将恶性肿瘤长期化疗并进行PICC置管术的患者150例,按随机数字表法分为盲穿组(A组)、超声引导下穿刺组(B组)、静脉造影引导及连续X线透视辅助穿刺组(C组),每组50例,各组均采用巴德公司生产的3项瓣膜式4F PICC导管。结果:一次置管成功率A组为72%,B组为90%,C组为92%,A、B组比较差异具有统计学意义(χ2=5.26,P<0.05);B、C组比较差异无统计学意义(χ2=0.12,P>0.05)。A组并发症的发生率为22%,B组为8%,C组为2%,A、B组比较差异具有统计学意义(χ2=3.84,P<0.05);B组并发症的发生率高于C组,但2组比较差异无统计学意义(χ2=1.89,P>0.05);置管操作时间A组为(12.8±3.1)min,B组为(8.4±1.2)min,C组为(5.2±2.1)min,A、B组比较差异具有统计学意义(P<0.05),B、C组比较差异具有统计学意义(P<0.05)。结论:采用静脉造影引导X线透视辅助下PICC置管术一次置管成功率与超声引导下无差别,但能降低并发症的发生率,减少操作时间。
Objective: To discuss the the safety and application values of PICC catheterization guided by veinography and aided by continuous X-ray fluoroscopy. Methods: All 150 patients who were suffering malignant tumor, undergoing long-term chemotherapy and performing PICC catheterization were divided into blind puncture group(group A), the group of puncture guided by ultrasound(group B), the group of puncture guided by veinography and aided by continuous X-ray fluoroscopy(group C) according to random number table method, 50 cases each group,the patients in different groups used three valves type 4 F PICC catheter produced by Budd Company. Results: The success rates of catheterization once of group A, group B and group C were 72%, 90% and 92%, the difference had statistical meaning when group A was compared with group B( χ2=5.26, P<0.05); the difference had no statistical meaning when group B was compared with group C( χ2=0.12, P >0.05). The incidences of the complications in group A, B and C were 22%, 8% and 2%, the difference showed statistical meaning when group A was compared with group B( χ2=3.84, P<0.05); the incidence of the compilications in group B was obviously higher than that of the group C, while the difference had no statistical meaning when group B was compared with group C( χ2=1.89, P>0.05);intubation operation time of three groups were(12.8±3.1)min,(8.4±1.2)min and(5.2±2.1)min, the difference was statistically significant in the comparison between A and B(P<0.05), there was a significant difference in the comparisons between B and C(P<0.05). Conclusion: There is no difference when the success rate of PICC catheterization once guided by veinography and aided by continuous X-ray fluoroscopy was compared with the rate guided by ultrasound, while catheterization guided by veinography and aided by continuous X-ray fluoroscopy could decrease the incidence of the complications and reduce operation time.
Objective: To discuss the the safety and application values of PICC catheterization guided by veinography and aided by continuous X-ray fluoroscopy. Methods: All 150 patients who were suffering malignant tumor, undergoing long-term chemotherapy and performing PICC catheterization were divided into blind puncture group(group A), the group of puncture guided by ultrasound(group B), the group of puncture guided by veinography and aided by continuous X-ray fluoroscopy(group C) according to random number table method, 50 cases each group,the patients in different groups used three valves type 4 F PICC catheter produced by Budd Company. Results: The success rates of catheterization once of group A, group B and group C were 72%, 90% and 92%, the difference had statistical meaning when group A was compared with group B( χ2=5.26, P<0.05); the difference had no statistical meaning when group B was compared with group C( χ2=0.12, P >0.05). The incidences of the complications in group A, B and C were 22%, 8% and 2%, the difference showed statistical meaning when group A was compared with group B( χ2=3.84, P<0.05); the incidence of the compilications in group B was obviously higher than that of the group C, while the difference had no statistical meaning when group B was compared with group C( χ2=1.89, P>0.05);intubation operation time of three groups were(12.8±3.1)min,(8.4±1.2)min and(5.2±2.1)min, the difference was statistically significant in the comparison between A and B(P<0.05), there was a significant difference in the comparisons between B and C(P<0.05). Conclusion: There is no difference when the success rate of PICC catheterization once guided by veinography and aided by continuous X-ray fluoroscopy was compared with the rate guided by ultrasound, while catheterization guided by veinography and aided by continuous X-ray fluoroscopy could decrease the incidence of the complications and reduce operation time.
引文
[1]刘春梅.超声引导结合改良塞丁格技术与传统中心静脉导管置管的比较[J].蚌埠医学院学报,2015,40(3):404-406.
[2]张晓玲,汪丹,周晶,等.两种不同方法处理肿瘤患者PICC置管后皮肤过敏的疗效分析[J].中华医院感染学杂志,2014,24(23):5869-5871.
[3]罗金莲,夏晓红,钟惠琴,等.赛丁格技术PICC置管不同时机局麻的对照研究[J].赣南医学院学报,2015,35(1):135-136.
[4]徐海英,谷小燕,王兰.超声引导下改良塞丁格PICC送管时导丝替换的效果观察[J].护理学报,2015,22(8):56-58.
[5]Bortolussi R,Zotti P,Conte M,et al.Quality of life,pain perception,and distress correlated to ultrasound-guided peripherally inserted central venous catheters in palliative care patients in a home or hospice setting[J].J Pain Symptom Manage,2015,50(1):118-123.
[6]范育英,陈林敏,蒋向玲,等.超声引导下改良型塞丁格技术置入PICC管的培训和管理[J].临床医学工程,2014,21(11):1466-1468.
[7]Cotogni P,Pittiruti M.Focus on peripherally inserted central catheters in critically ill patients[J].World Journal of Critical Care Medicine,2014,3(4):80-94.
[8]刘丽艳,孙清阳,马鸣丽,等.如何提高PICC塞丁格彩色影像置入技术[J].中国实用医药,2015,10(2):215-216.
[9]Carr PJ,Rippey JC.Upper extremity deep vein thrombosis:a complication of an indwelling peripherally inserted central venous catheter[J].Clin Case Rep,2015,3(3):170-174.
[10]黄秋妹,胡敏芝,李莲英,等.上肢PICC穿刺外测量置管长度方法研究[J].护理研究,2015,29(2):208-209.
[11]李东海,程芳,朱超逸,等.超声引导改良外周静脉导入中心静脉置管术临床应用经验[J].现代生物医学进展,2015,15(2):298-301.
[12]朱竹华,顾菊凤,曹岳蓉,等.非超声引导下改良塞丁格技术在肿瘤患者中心静脉导管置管中的效果观察[J].检验医学与临床,2013,10(20):2777-2778.
[13]苏里亚,张征,李慧玲.彩色多普勒超声对PICC置管术后血栓形成诊断的价值[J].中西医结合心脑血管病杂志,2013,11(10):1206-1207.
[14]高东霞.PICC尖端定位及移位的研究进展[J].护理学杂志,2015,30(7):110-113.
[15]汪丹,张晓玲,陈美玲,等.超声引导下行外周静脉置入中心静脉导管的穿刺方法研究[J].中国临床保健杂志,2015,18(2):213-214.
[2]张晓玲,汪丹,周晶,等.两种不同方法处理肿瘤患者PICC置管后皮肤过敏的疗效分析[J].中华医院感染学杂志,2014,24(23):5869-5871.
[3]罗金莲,夏晓红,钟惠琴,等.赛丁格技术PICC置管不同时机局麻的对照研究[J].赣南医学院学报,2015,35(1):135-136.
[4]徐海英,谷小燕,王兰.超声引导下改良塞丁格PICC送管时导丝替换的效果观察[J].护理学报,2015,22(8):56-58.
[5]Bortolussi R,Zotti P,Conte M,et al.Quality of life,pain perception,and distress correlated to ultrasound-guided peripherally inserted central venous catheters in palliative care patients in a home or hospice setting[J].J Pain Symptom Manage,2015,50(1):118-123.
[6]范育英,陈林敏,蒋向玲,等.超声引导下改良型塞丁格技术置入PICC管的培训和管理[J].临床医学工程,2014,21(11):1466-1468.
[7]Cotogni P,Pittiruti M.Focus on peripherally inserted central catheters in critically ill patients[J].World Journal of Critical Care Medicine,2014,3(4):80-94.
[8]刘丽艳,孙清阳,马鸣丽,等.如何提高PICC塞丁格彩色影像置入技术[J].中国实用医药,2015,10(2):215-216.
[9]Carr PJ,Rippey JC.Upper extremity deep vein thrombosis:a complication of an indwelling peripherally inserted central venous catheter[J].Clin Case Rep,2015,3(3):170-174.
[10]黄秋妹,胡敏芝,李莲英,等.上肢PICC穿刺外测量置管长度方法研究[J].护理研究,2015,29(2):208-209.
[11]李东海,程芳,朱超逸,等.超声引导改良外周静脉导入中心静脉置管术临床应用经验[J].现代生物医学进展,2015,15(2):298-301.
[12]朱竹华,顾菊凤,曹岳蓉,等.非超声引导下改良塞丁格技术在肿瘤患者中心静脉导管置管中的效果观察[J].检验医学与临床,2013,10(20):2777-2778.
[13]苏里亚,张征,李慧玲.彩色多普勒超声对PICC置管术后血栓形成诊断的价值[J].中西医结合心脑血管病杂志,2013,11(10):1206-1207.
[14]高东霞.PICC尖端定位及移位的研究进展[J].护理学杂志,2015,30(7):110-113.
[15]汪丹,张晓玲,陈美玲,等.超声引导下行外周静脉置入中心静脉导管的穿刺方法研究[J].中国临床保健杂志,2015,18(2):213-214.