改变股静脉穿刺置管深度在上腔静脉压迫综合征患者中的应用效果观察(1)
【摘要】 目的 探讨改变股静脉穿刺置管深度在上腔静脉压迫综合征患者中的应用效果。方法 将2013年1月～2018年6月73例(研究組)需股静脉置管的患者增加置管深度至30 cm，与2008年6月～2012年12月的 61例(对照组)股静脉置管患者进行比较，观察其置管效果和并发症发生率。结果 两组患者的置管效果比较，一次性穿刺成功率、一次置管成功率和留置时间比较，差异均无统计学意义(均P>0.05);两组患者置管的并发症比较，导管相关感染发生率差异无统计学意义(P>0.05)，而研究组血栓发生率明显低于对照组，差异有统计学意义(P<0.05)。结论 改变股静脉穿刺置管的深度，使导管尖端到达下腔静脉，可以有效减少血栓的发生，对生存期<1个月的患者和有经济及维护条件限制的患者有一定的实用价值。
【关键词】 股静脉置管;置管深度;并发症
中图分类号：R472 文献标志码：A DOI：10.3969/j.issn.1003-1383.2019.07.011
【Abstract】 Objective To investigate the effect of changing the depth of femoral vein puncture and catheter in patients with superior vena cava compression syndrome.Methods The depth of catheter was increased to 30 cm in 73 patients(study group) who needed femoral vein catheter from January 2013 to June 2018，and the study group were compared with 61 patients(control group) who needed femoral vein catheter from June 2008 to December 2012.And then，the effect of catheter and the incidence of complications were observed between the two groups.Results Among the comparison of catheter effects，there was no statistically significant difference in the success rate of one-time puncture，the success rate of one-time catheter and indwelling time between the two groups(all P>0.05).Among the comparison of complications of catheter，the difference of incidence of catheter-related infection between the two groups was not statistically significant(P>0.05)，while the incidence of thrombus in the study group was significantly lower than that in the control group，difference was statistically significant(P<005).Conclusion Changing the depth of femoral vein puncture and catheter to make the catheter tip reach to inferior vena cava can effectively reduce the occurrence of thrombosis，and has certain practical value for patients with survival time less than 1 month and patients with economic and maintenance constraints.
【Key words】 femoral vein catheter;depth of catheter;complication
经外周静脉穿刺中心静脉置管(Peripherally inserted central catheter，PICC)因其操作简单、安全和并发症少等因素广泛地应用于临床;而股静脉穿刺置管因穿刺点特殊的解剖位置，容易有较高感染率、并发症较多和活动不方便等特点[1～2]，不作为长期留置中心静脉导管的首选部位[2]。但是部分癌症患者由于肿瘤侵犯挤压上腔静脉，或由于胸腔内淋巴结肿大，对上腔静脉形成压迫，导致上腔静脉梗阻，出现胸部、上肢、颈部和颜面淤血、水肿等症状，这类患者应避免选择上肢静脉穿刺输液[3]。2013年1月～2018年6月，我科对73例(研究组)需行股静脉置管的患者增加置管深度，并与2008年6月～2012年12月的 61例(对照组)行股静脉置管的患者比较，其并发症(血栓)发生率明显下降，现报告如下。
1 资料与方法1.1 一般资料 选择我科2013年1月～2018年6月行股静脉穿刺置管术的上腔静脉压迫综合征的患者73例作为研究组，均为肺癌患者，其中男38例，女 35例;年龄34～76岁，平均(61.64±9.12)岁。另选择2008年6月～2012年12月行股静脉穿刺置管术61例为对照组，也均为肺癌患者，其中男35例，女 26例;年龄38～69岁，平均(59.63±7.46)岁。两组患者一般资料比较差异无统计学意义(P>0.05) ，具有可比性。, http://www.100md.com(刘梅凤 伍美娟 刘秋梅 李竞长)
【关键词】 股静脉置管;置管深度;并发症
中图分类号：R472 文献标志码：A DOI：10.3969/j.issn.1003-1383.2019.07.011
【Abstract】 Objective To investigate the effect of changing the depth of femoral vein puncture and catheter in patients with superior vena cava compression syndrome.Methods The depth of catheter was increased to 30 cm in 73 patients(study group) who needed femoral vein catheter from January 2013 to June 2018，and the study group were compared with 61 patients(control group) who needed femoral vein catheter from June 2008 to December 2012.And then，the effect of catheter and the incidence of complications were observed between the two groups.Results Among the comparison of catheter effects，there was no statistically significant difference in the success rate of one-time puncture，the success rate of one-time catheter and indwelling time between the two groups(all P>0.05).Among the comparison of complications of catheter，the difference of incidence of catheter-related infection between the two groups was not statistically significant(P>0.05)，while the incidence of thrombus in the study group was significantly lower than that in the control group，difference was statistically significant(P<005).Conclusion Changing the depth of femoral vein puncture and catheter to make the catheter tip reach to inferior vena cava can effectively reduce the occurrence of thrombosis，and has certain practical value for patients with survival time less than 1 month and patients with economic and maintenance constraints.
【Key words】 femoral vein catheter;depth of catheter;complication
经外周静脉穿刺中心静脉置管(Peripherally inserted central catheter，PICC)因其操作简单、安全和并发症少等因素广泛地应用于临床;而股静脉穿刺置管因穿刺点特殊的解剖位置，容易有较高感染率、并发症较多和活动不方便等特点[1～2]，不作为长期留置中心静脉导管的首选部位[2]。但是部分癌症患者由于肿瘤侵犯挤压上腔静脉，或由于胸腔内淋巴结肿大，对上腔静脉形成压迫，导致上腔静脉梗阻，出现胸部、上肢、颈部和颜面淤血、水肿等症状，这类患者应避免选择上肢静脉穿刺输液[3]。2013年1月～2018年6月，我科对73例(研究组)需行股静脉置管的患者增加置管深度，并与2008年6月～2012年12月的 61例(对照组)行股静脉置管的患者比较，其并发症(血栓)发生率明显下降，现报告如下。
1 资料与方法1.1 一般资料 选择我科2013年1月～2018年6月行股静脉穿刺置管术的上腔静脉压迫综合征的患者73例作为研究组，均为肺癌患者，其中男38例，女 35例;年龄34～76岁，平均(61.64±9.12)岁。另选择2008年6月～2012年12月行股静脉穿刺置管术61例为对照组，也均为肺癌患者，其中男35例，女 26例;年龄38～69岁，平均(59.63±7.46)岁。两组患者一般资料比较差异无统计学意义(P>0.05) ，具有可比性。, http://www.100md.com(刘梅凤 伍美娟 刘秋梅 李竞长)