肺结核患者应用超声引导下改良Seldinger技术实施经外周静脉置入中心静脉导管的效果研究

doi:10.3969/j.issn.2095-3755.2020.01.015

摘要/Abstract

摘要：

目的对比分析超声引导下改良Seldinger技术与盲穿法实施经外周静脉置入中心静脉导管(peripherally inserted central venous catheters,PICC)在肺结核患者中的应用效果。方法搜集2016年3月至2018年3月昆明市第三人民医院住院治疗的150例行PICC的肺结核患者作为研究对象。根据PICC置管方式进行分组,将接受行盲穿法进行PICC置管的70例患者纳入对照组,将行超声引导下改良Seldinger技术进行PICC置管的80例患者纳入观察组,对比两组患者的置管效果。结果观察组一次性穿刺成功率为97.5%(78/80),一次性置管成功率为100.0%(80/80),均明显高于对照组的85.7%(60/70)和92.9%(65/70),差异均有统计学意义(χ²值分别为7.05、5.91,P值分别为0.008、0.015)。观察组置管后并发症发生率为5.0%(4/80),明显低于对照组的21.4%(15/70),差异有统计学意义(χ²=9.11,P=0.003)。结论超声引导下改良Seldinger技术对肺结核患者进行PICC置管的效果优于盲穿法,具有较高的安全性。

关键词: 结核,肺, 导管插入术,中心静脉, 超声检查,介入性, 插管法, 对比研究

Abstract:

Objective To compare and analyze the application effect of ultrasound-guided modified Seldinger technique and blind puncture for the implementation of peripherally inserted central venous catheter (PICC) in patients with pulmonary tuberculosis (PTB). Methods A total of 150 patients with PTB underwent PICC in Kunming Third People’s Hospital from March 2016 to March 2018 were collected as research subjects, and then divided into two groups according to the mode of PICC catheterization. Concretely, 70 patients who received PICC catheterization by blind puncture were included in the control group, and 80 patients who underwent PICC catheterization with ultrasound-guided modified Seldinger technique were included in the observation group, and the effects of catheterization were compared between the two groups. Results The success rates of one-time puncture and catheterization in the observation group were 97.5% (78/80) and 100.0% (80/80), respectively, which were significantly higher than those in the control group (85.7% (60/70) and 92.9% (65/70), respectively), with the statistically significant differences (χ²=7.05 and 5.91, P=0.008 and 0.015, respectively). The incidence of complications after catheterization in the observation group was significantly lower than that in the control group (5.0% (4/80) vs. 21.4% (15/70)), with the statistically significant differences (χ²=9.11, P=0.003). Conclusion The effect of ultrasound-guided modified Seldinger technique on PICC catheterization in patients with PTB is better than that of blind puncture, and it has higher safety.

Key words: Tuberculosis, lung, Catheterization, central vein, Ultrasound, interventional, Intubation, Comparative study

赵雁红, 马云红, 吴国静. 肺结核患者应用超声引导下改良Seldinger技术实施经外周静脉置入中心静脉导管的效果研究[J]. 结核病与肺部健康杂志, 2020, 9(1): 68-71. doi: 10.3969/j.issn.2095-3755.2020.01.015

ZHAO Yan-hong, MA Yun-hong, WU Guo-jing. Study on the effect of peripherally inserted central venous catheter in patients with pulmonary tuberculosis using ultrasound-guided modified Seldinger technique[J]. Journal of Tuberculosis and Lung Health, 2020, 9(1): 68-71. doi: 10.3969/j.issn.2095-3755.2020.01.015

图/表 2

参考文献 13

[1]	Abusedera M, Alkady O . Ultrasound-guided pleural effusion drainage with a small catheter using the single-step trocar or modified Seldinger technique. J Bronchology Interv Pulmonol, 2016,23(2):138-145.
[2]	朱晓麟, 谢敬, 孙书杰 , 等. 超声引导与传统盲穿置入PICC导管的疗效探讨. 哈尔滨医科大学学报, 2014,29(5):431-432.
[3]	张云, 吴志娟, 徐文藻 . 超声引导下使用改良Seldinger技术置入PICC导管的临床观察. 实用临床医药杂志, 2014,18(14):45-46.
[4]	翟怀香, 付小伟 . 血管超声联合改良塞丁格技术与盲穿置入PICC应用于高龄AD患者的效果比较. 实用临床医药杂志, 2014,18(8):23-25.
[5]	杨静, 宋迪, 徐令婕 . 2种PICC穿刺法致机械性静脉炎的对比分析. 中华全科医学, 2014,12(4):635-637.
[6]	Moslim MA, Falk GA, Seifarth FG . Novel modified Seldinger technique for gastrojejunal feeding tube placement. JSLS, 2018,22(1):e2017.00091.
[7]	陈丽琴 . 使用彩超结合改良赛丁格技术引导PICC的临床应用. 四川医学, 2014,28(9):1229-1232.
[8]	林瑞端, 郭琛, 梁芳 . B超引导下采用改良塞丁格技术进行中心静脉导管置管的优势. 实用临床医药杂志, 2014,18(6):4-6.
[9]	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. 中国临床保健杂志, 2015,23(2):213-214.
[10]	马山, 任伟, 王莉 , 等. 肺动脉血栓栓塞26例临床诊断与介入治疗. 中国临床研究, 2013,26(2):110-112.
[11]	Pardo MA, Divers S . Jugular central venous catheter placement through a modified Seldinger technique for long-term venous access in chelonians. J Zoo Wildl Med, 2016,47(1):286-290.
[12]	魏雪, 刘宝芝, 连宝营 . 超声引导下PICC置管与传统盲穿法置管的临床对照研究. 中国医药导刊, 2015,17(9):968.
[13]	王璇 . 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. 中国医药导报, 2014,36(25):50-53.

组别	例数	穿刺点渗血	机械性静脉炎	静脉血栓	皮下淤血	合计
观察组	80	1(1.2)	0(0.0)	1(1.2)	2(2.5)	4(5.0)
对照组	70	5(7.1)	2(2.9)	3(4.3)	5(7.1)	15(21.4)
χ²值		3.38	2.32	1.33	1.81	9.11
P值		0.070	0.130	0.250	0.180	0.000

组别	护理质量	护理技巧	护理态度	总分
观察组	93.58±2.36	94.82±2.54	96.67±2.39	95.64±2.28
对照组	81.47±5.59	81.05±4.87	82.28±5.19	81.33±5.31
t值	17.67	22.09	22.26	21.91
P值	0.000	0.000	0.000	0.000

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[5]	马岩, 杨晓军, 任振娟, 苏云开. 痰标本基因芯片法检测耐多药肺结核的临床价值[J]. 结核与肺部疾病杂志, 2020, 1(2): 112-116.
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[10]	毛毅, 吴桂辉, 陈娟, 陈洪德. 肺保护性通气策略在肺结核并发HIV感染者机械通气中的应用研究[J]. 结核与肺部疾病杂志, 2020, 1(1): 45-48.
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[13]	柳杞,李冰. 同伴支持的护理干预对慢性阻塞性肺疾病患者呼吸功能与生活质量的影响[J]. 结核病与肺部健康杂志, 2019, 8(1): 69-72.
[14]	李妍,张慧玲,欧阳玲. 女性盆腔结核与卵巢上皮癌的诊断与鉴别诊断[J]. 结核病与肺部健康杂志, 2019, 8(1): 60-64.
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