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目的 探讨早产儿应用外周穿刺中心静脉导管 (PICC)的价值。方法 对 84例早产儿采用 1 9Fr规格导管行置管术。结果 84例患儿中 7例因导管堵塞等先后 2次施行PICC置入术 ,实际完成 91例次。穿刺贵要静脉 6 0例次、正中静脉 2 2例次、头静脉 7例次 ,导管顶端到达上腔静脉发生率分别为 6 1 6 7%、2 2 2 7%与14 2 9% ,差异有显著意义 (P <0 0 5 ) ;穿刺大隐静脉和前臂静脉各 1例。感染发生率为 4 2 9%。导管留置 3～6 8天 ,平均 (2 1 2 7± 15 14)天。完成治疗按计划拔管 75例次占 82 42 % ,因导管堵塞或脱出拔管各 5例次各占5 49% ,因导管裂拔管 3例次占 3 30 % ,因静脉炎拔管 2例次占 2 2 0 % ,因穿刺部位局部感染拔管 1例次占1 10 %。结论 早产儿应用PICC能有效解决建立通畅静脉通道的问题 ,穿刺血管首选贵要静脉 ;熟练掌握导管使用技术后可降低导管相关感染及因导管堵塞而致拔管的发生率。
Objective To investigate the value of peripheral puncture central venous catheter (PICC) in preterm infants. Methods 84 cases of premature children with 19Fr catheter catheterization. Results Of the 84 children, 7 were followed up PICC for 2 times due to catheter blockage, and 91 cases were actually completed. Sixty cases of puncture of valuable vein, 22 cases of median vein and 7 cases of cephalic vein were performed. The incidences of superior vena cava reaching the catheter tip were 61.7%, 22.7% and 14.29%, respectively (P <0.05); puncture of saphenous vein and forearm vein in 1 case. Infection rate was 42.9%. Catheters were left for 3-6 days, averaging (21 72 ± 15 14) days. The completion of treatment according to the plan extubation 75 cases accounted for 82 42%, due to catheter block or extubation 5 cases each accounted for 5 49%, 3 cases due to catheter fissure tube 30%, due to phlebitis extubation 2 Cases accounted for 220%, due to local infection of the puncture site extubation 1 cases accounted for 1 10%. Conclusions The application of PICC in preterm infants can effectively solve the problem of establishing an unobstructed venous access. Puncture of blood vessels is the first choice for the needles. Proficiency in catheter management can reduce the incidence of catheter-related infections and extubation due to catheter blockage.