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目的分析床旁超声辅助早产儿脐静脉导管(UVC)置管术的临床价值,以期寻找降低UVC置管术并发症率、提升UVC置管术质量。方法选择2015年6月-2016年12月在东莞市妇幼保健院行UVC置管的104例早产儿随机分为试验组50例和对照组54例,两组患儿置管前均根据患儿体重计算插管深度。插管到计算深度后,对照组即行固定,行X线胸腹片检查;位置出现不能接受的偏差应调整管端位置后再固定,行X线胸腹片检查;后均予床边超声检查,确定管端位置。试验组患儿插管到计算深度后,行床边超声检查,确定管端位置,并在超声引导下调整管端位置,固定后行X线胸腹片检查了解管端位置。床旁超声检查管端位置正确(位置正确定义为右心房与下腔静脉交界附近)为成功,对比两组患儿一次性插管到位成功率、插管所用平均时间、插管固定次数及两组患儿导管留置时间、因并发症拔管率、插管后2周内并发症情况。结果试验组患儿插管一次成功率为84.00%(42/50),对照组患儿为51.85%(28/54),两组差异有统计学意义(P<0.05);试验组患儿插管所用时间为(9.5±2.1)min、插管固定次数(1.1±0.1)次明显低于对照组的(13.7±3.5)min和(1.6±0.2)次,差异有统计学意义(P<0.05);试验组患儿插管后2周内插管相关并发症率2.00%(1/50)明显低于对照组的9.26%(5/54),因并发症拔管率低于对照组,差异均有统计学意义(P<0.05);两组患儿导管留置时间差异无统计学意义(P>0.05)。结论床旁超声辅助早产儿脐静脉导管置管术可有效提升置管质量,且避免了多次X线检查可能产生的辐射损伤,对早产儿脐静脉导管置管具有较高的临床价值。
Objective To analyze the clinical value of ultrasonography-assisted umbilical vein catheterization (UVC) in bedside in order to find out the way to reduce the complication rate of UVC catheterization and improve the quality of UVC catheterization. Methods Select from June 2015 to December 2016 in Dongguan City MCH underwent 104 cases of premature children were randomly divided into experimental group 50 cases and control group of 54 cases, both groups of children before catheterization were based on children Weight calculation intubation depth. After intubation to the calculated depth, the control group was fixed, line X-ray examination of the thoracoabdominal disc; position unacceptable deviation should be adjusted after the tube end position and then fixed, X-ray examination of thoracoabdominal; after bedside ultrasound examination , Determine the tube end position. After intubation of the experimental group to the calculated depth, the bedside ultrasound examination was performed to determine the position of the tube end. The position of the tube end was adjusted under the guidance of ultrasound and the position of the tube end was checked by X-ray thoracoabdominal examination. Bedside ultrasound examination of the tube end position is correct (the location is correctly defined as the right atrium and near the junction of the inferior vena cava) as a success, compared two groups of children with one-time success rate of intubation, intubation with the average time, the number of intubation and two Group of children with catheter indwelling time, due to complications of extubation rate, complications within 2 weeks after intubation. Results The successful rate of intubation was 84.00% (42/50) in the experimental group and 51.85% (28/54) in the control group, with significant difference between the two groups (P <0.05). In the experimental group, The duration of intubation was (9.5 ± 2.1) min and the duration of intubation (1.1 ± 0.1) was significantly lower than that of the control group (13.7 ± 3.5) min and (1.6 ± 0.2), respectively, with significant difference (P <0.05 ). The rate of intubation-related complications in trial group was 2.00% (1/50) less than 9.26% (5/54) in control group within 2 weeks after intubation. The rate of extubation was lower than that in control group, (P <0.05). There was no significant difference in catheter indwelling time between the two groups (P> 0.05). Conclusion The bedside ultrasound-assisted umbilical vein catheterization in preterm infants can effectively improve the quality of catheterization and avoid the possible radiation damage caused by multiple X-ray examination. It has a high clinical value for umbilical vein catheterization in premature infants.