棋牌大全下载安装

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                      • 当前位置: 代写一篇论文多少钱 > 医学论文 > PICC置管新生患儿非计划性拔管成因与危险因素探究

                        PICC置管新生患儿非计划性拔管成因与危险因素探究

                        时间:2019-03-13 14:56作者:谢洁 张先红 范娟
                        本文导读:这是一篇关于PICC置管新生患儿非计划性拔管成因与危险因素探究的文章,静脉输液是住院新生儿最常用的给药方式,经外周静脉穿刺中心静脉置管(PICC)具有留置时间长、穿刺部位选择多、操作简便、耐高渗、组织相容性好等优点,已在新生儿病房广泛运用。

                          摘    要: [目的]探讨新生儿PICC导管非计划性拔管的原因及高危因素;[方法]回顾性分析2015年6月~2017年6月间696例新生儿PICC置管患儿,其中38例为非计划性拔管,了解非计划性拔管的原因,并通过组间比较的方法探讨非计划性拔管的高危因素;[结果]非计划性拔管率为5.46%(38/696),其中前三位原因分别为导管堵管20例、静脉炎6例及导管异位4例,共占78.95%(30/38)。从PICC非计划性拔管的危险因素分析中得出:患儿性别、输注液体、导管留置时间等因素于两组间无统计学意义P>0.05,胎龄(OR=2.273, 95%CI:1.222~4.227,P =0.010),出生体质量(OR=1.004, 95%CI:1.001~1.008, P=0.021),未采取镇静安抚措施(OR=41.181,95%CI:9.904~171.227, P<0.001),为非计划性拔管的3个主要高危因素。[结论]导管堵管是新生儿PICC导管非计划性拔管的首要原因,早产儿孕周及体质量越小,未采取镇静安抚措施可增加非计划性拔管的风险。

                          关键词: 婴儿,新生; 导管插入术,外周; 非计划性拔管; 危险因素;

                          Abstract:棋牌大全下载安装 [Objective]To investigate the causes and risk factors of unexpected extubation of PICC catheter in neonates.[Methods]A total of 696 neonates with PICC catheter between June 2015 to June 2017 was retrospectively analyzed, of these, 38 cases were unplanned extubation. The causes of unexpected extubation was described and the high risk factors of unplanned extubation were discussed by comparing the unexpected extubation group and the planned extubation group. [Results]The rate of unplanned extubation was 5.46% (38/696). The first three reasons were catheter occlusion, phlebitis and ectopic catheterization respectively, which accounted for 78.95% of the unplanned extubation. Gestational age (OR=2.273, 95%CI 1.222~4.227,P =0.010),birth weight (OR=1.004, 95%CI 1.001~1.008, P=0.021),no sedation or pacifying measures (OR=41.181,95%CI 9.904~171.227, P<0.001) were major risks of unexpected extubation. [Conclusions]Catheter occlusion is the first reason for unplanned extubation of PICC catheter in neonates. Less gestational age and birth weight, no sedation or pacifying measures could increase the risk of unexpected extubation.

                          Keyword: infant,newborn; catheterization,peripheral; unplanned extubation; risk factors;

                          JINGMAISHUYESHIZHUYUANXINSHENGERZUICHANGYONGDEJIYAOFANGSHI,JINGWAIZHOUJINGMAICHUANCIZHONGXINJINGMAIZHIGUAN(PICC)JUYOULIUZHISHIJIANZHANG、CHUANCIBUWEIXUANZEDUO、CAOZUOJIANBIAN、NAIGAOSHEN、ZUZHIXIANGRONGXINGHAODENGYOUDIAN,YIZAIXINSHENGERBINGFANGGUANGFANYUNYONG[1]。DANZAIPICCSHIYONGGUOCHENGZHONG,YINGEZHONGYINSUDAOZHIDEFEIJIHUAXINGBAGUAN,SHIHUANERMIANLINZAICICHUANCIFENGXIAN,TONGSHIZENGJIAZHUYUANFEIYONGJIHULIRENYUANDEGONGZUOLIANG。WEILEJIEPICCFEIJIHUAXINGBAGUANDEYUANYINJIGAOWEIYINSU,YIBIANYOUZHENDUIXINGDICAIQUCUOSHIYUFANGFEIJIHUAXINGBAGUAN,XIANDUIBENYUANXINSHENGERZHENZHIZHONGXINXINGPICCZHIGUANDEHUANERJINXINGHUIGUXINGFENXI,XIANBAODAORUXIA。

                          1、资料与方法

                          1.1、一般资料

                          XUANQU2015NIAN6YUEZHI2017NIAN6YUEBENYUANXINSHENGERZHENZHIZHONGXIN761LIXINGPICCZHIGUANHUANERWEIYANJIUDUIXIANG,PAICHUJIASHUQIANZICHUYUAN、SIWANG65LI,GONGYOU696LIHUANERNARUBENYANJIU。QIZHONGNAN362LI(52.01%),NV334(47.99%),PINGJUNTAILING(32.84±1.79)ZHOU,PINGJUNCHUSHENGTIZHILIANG(1 524.14±328.87)g,ZHIGUANCAILIAOJUNWEIMEIGUOBDGONGSISHENGCHANDE1.9 FrDAOGUAN,ZHIGUANBUWEIYICIWEINIEQIANJINGMAI224LI(32.18%)、DAYINJINGMAI220LI(31.61%)、GUIYAOJINGMAI194LI(27.87%)、YEJINGMAI34LI(4.89%)、JINGWAIJINGMAI14LI(2.01%)、TOUJINGMAI10LI(1.44%)。

                          1.2、方法

                          1.2.1、非计划性拔管定义及指征

                          非计划性拔管是指各种原因导致导管功能丧失,但治疗尚未结束不得已而拔除导管[2]。非计划性拔管的指征包括:导管堵塞无法再通,临床怀疑导管相关性感染经抗生素治疗后无好转,导管尖端堵塞,导管滑脱及其他PICC并发症等[3]。
                         

                        PICC置管新生患儿非计划性拔管成因与危险因素探究
                         

                          1.2.2、临床资料的收集与分析

                          CAIYONGHUIGUXINGDIAOCHADEFANGFA,SHOUJINARUBENYANJIUHUANERDEYUNZHOU、CHUSHENGTIZHILIANG、SHENGHOURILING、ZHUYAOZHENDUAN、YONGYAOQINGKUANG、ZHIGUANBUWEI、LIUZHIDAOGUANSHIJIANDENGXINXI,LEJIEFEIJIHUAXINGBAGUANDEZHUYAOYUANYIN,TONGSHIJIANGJIHUABAGUANZUYUFEIJIHUABAGUANZUJINXINGDUIBIFENXI,TANTAOFEIJIHUAXINGBAGUANDEGAOWEIYINSU。

                          1.3、统计学处理

                        棋牌大全下载安装   CAIYONGSPSS21.0 RUANJIANJINXINGSHUJUFENXI,ZHENGTAIHUOJINSIZHENGTAIFENBUDEJILIANGZILIAOYI±sBIAOSHI,PIANTAIFENBUDEJILIANGZILIAOYIM(Q1,Q3)BIAOSHI,BIJIAOCAIYONGFANGCHAJIANYAN;JISHUZILIAOYIPINSHUHUOBAIFENLVBIAOSHI,BIJIAOCAIYONGx2JIANYAN;CAIYONGLogisticHUIGUIJINXINGXIANGGUANXINGFENXI,YIP<0.05WEICHAYIYOUTONGJIXUEYIYI。

                          2、结果

                          2.1、新生儿PICC导管非计划性拔管率

                        棋牌大全下载安装   696LIXINGPICCZHIGUANDEHUANERZHONG,FEIJIHUAXINGBAGUANGONG38LI(5.46%)。QIZHONG,NAN22LI(57.89%),NV16LI(42.11%),ZHIGUANSHITIZHILIANG(1 262.63±429.52)g,ZHIGUANSHIJIAOZHENGTAILINGWEI(30.95±2.13)ZHOU,ZHIGUANSHIRILINGWEI7(2,16)d,DAOGUANLIUZHITIANSHUWEI(26.63±16.94)d。

                          2.2、 PICC非计划性拔管原因分析

                          XINSHENGERPICCDAOGUANFEIJIHUAXINGBAGUANYUANYINZHONG,PAIMINGQIAN3WEIDEFENBIEWEIDAOGUANDUGUAN、JINGMAIYANJIDAOGUANYIWEI,GONGZHAN78.95%(30/38)。QIZHONG20LIDAOGUANDUGUANZHONG,YOU10LIWEIDAOGUANNEICHENDIANWUWUFACHONGXIGANJINGERBAGUAN。6LIJINGMAIYAN,FASHENGSHIJIANFENBIEWEIZHIGUANHOU45、58、63、69、72HE75 h。4LIDAOGUANYIWEIZHONG,FASHENGYUGUIYAOJINGMAIHETOUJINGMAIGE2LI,JIANTU1。

                          图1 新生儿PICC导管非计划性拔管的原因
                        图1 新生儿PICC导管非计划性拔管的原因

                          2.3 、PICC非计划性拔管的危险因素分析

                          BENYANJIUDUIJIHUAXINGBAGUANZUHEFEIJIHUAXINGBAGUANZUJINXINGBIJIAO,JIEGUOXIANSHILIANGZUTAILING、CHUSHENGTIZHILIANG、CHUANCIBUWEIHESHIFOUCAIQUZHENJINGANFUCUOSHIDENGYINSUBIJIAO,CHAYIYOUTONGJIXUEYIYI(P<0.05)。JIANGZHEIXIEYINSUJINXINGDUOYINSULogisticHUIGUIFENXI,JIEGUOXIANSHITAILING(OR=2.273, 95%CI:1.222~4.227,P =0.010)、CHUSHENGTIZHILIANG(OR=1.004, 95%CI:1.001~1.008, P=0.021)HEWEICAIQUZHENJINGANFUCUOSHI(OR=41.181,95%CI:9.904~171.227, P<0.001)WEIFEIJIHUAXINGBAGUANDEGAOWEIYINSU。

                          表1 新生儿PICC导管非计划性拔管的高危因素
                        表1 新生儿PICC导管非计划性拔管的高危因素

                        棋牌大全下载安装   a:ZHENJINGCUOSHIBAOKUOSHIYONGZHENJINGJI、ANFUNAIZUI、XINFENGSHIBAOGUO、DAISHUSHIHULIDENGCUOSHI。

                          3、讨论

                          3.1、非计划性拔管的原因分析

                        棋牌大全下载安装   BENYANJIUXINSHENGERPICCDAOGUANFEIJIHUABAGUANLVWEI5.46%,DIYUGUONEIQITABAODAODE7.25%~17.50%DEFEIJIHUABAGUANLV[3,4,5]。FEIJIHUABAGUANDEQIAN3WEIYUANYINFENBIEWEIDAOGUANDUGUAN、JINGMAIYANJIDAOGUANYIWEI,YUYUZHUOWENDENG[5]、LIBIANE[6]HEZHANGYUNLANDENG[7]DENGBAODAOXIANGSI。

                          3.1.1、导管堵管

                        棋牌大全下载安装   BENYANJIUDAOGUANDUGUANGONGYOU20LI,BIAOXIANWEIJIYAOJISHUYEKUNNAN,CHOUBUCHUHUIXUE,CHONGGUANSHIZUSAI,YOUSHIKEJIANXUENINGKUAI。DAOGUANDUSAIFENWEIXUESHUANXINGHEFEIXUESHUANXINGLIANGZHONG,QIANZHEZHUYAOYINXINSHENGERXUEGUANQIANGXIAO,GUANBIBO,ZHIGUANYISUNSHANGNEIMOYINQIXUESHUAN,ZAOQIZAIDAOGUANWAIBIXINGCHENGXIANWEIQIAO,JIERXINGCHENGJIABANMOJIANHUANYETILIUDONGSUDU,YANZHONGSHIKEDAOZHIDAOGUANQUANBUDUSAI[8]。HOUZHECHANGYUYIXIETESHUYAOWU,RUJINGMAIYINGYANGSHIZHIFANGRUJIDESHIYONGYOUGUAN,ZHIFANGRUJIYOUYURONGZHIHANLIANGGAO,JIYIZAIDAOGUANZHONGCHENJI,HUOYIXIECUNZAIPEIWUJINJIDEYAOWURONGYICHENJIZAIDAOGUANNEI,JINERPOHUAIDAOGUANDEGUANGZEDU,DAOZHIXIJUNTINGLIUFANZHIZENGJIADAOGUANGANRANDEFENGXIAN[8]。

                          3.1.2、静脉炎

                        棋牌大全下载安装   JINGMAIYANSHIZHIYOUYUHUAXUE、GANRANJIWULIDENGYINSUDUIXUEGUANBICIJIERDAOZHIDEXUEGUANBIYANZHENG,ZHUYAOBAOKUOHUAXUEXINGJINGMAIYANHEJIXIEXINGJINGMAIYANLIANGLEI,YIJIXIEXINGJINGMAIYANDUOJIAN,WEIZHIGUANSHIHUOZHIGUANHOUDAOGUANZAIXUEGUANZHONGFANFUYIDONG、SUNSHANGXUEGUANNEIMOYINQI,TONGCHANGFASHENGZAIZHIGUANHOU48~72 h[9,10],BENYANJIU6LIFASHENGSHIJIANYUCIJIBENWENHE。JUWENXIANBAODAO,FASHENGJIXIEXINGJINGMAIYANDEYUANYINRUXIA:(1)YUCHUANCIXUEGUANDEJIEPOUTEDIANYOUGUAN,SUOYOUXINGJINGZHOUBUDETOUBEIJINGMAIJUNYOUXIAXIANGSHANGZHUJIANBIANXI,CIXUEGUANJINGMAIBANJIAODUOQIEGAODIQIFU,CHUANCIGUOCHENGZHONGRONGYIYINQIXUEGUANNEIPIHEJINGMAIBANMODEJIXIEXINGSUNSHANG;(2)YUKAOJINGUANJIECHU,HUANERCHUANCICEZHITIGUODUYUNDONGYOUGUAN[11],RUOZHIGUANCEZHITIPINFANQUSHENYUNDONG,DAOGUANBUDUANJIXIEMOCAXUEGUANNEIMOHEJINGMAIBAN,DAOZHIXUEGUANNEIMOSHOUSUN;(3)YUHULIRENYUANDECAOZUOJISHUYOUGUAN,CHUANCIBUSHULIANSHIXUYAOFANFUCHAGUAN,RONGYIYINQIJINGMAIBANHEXUEGUANNEIMODESUNSHANG;HANYINGDENG[12]RENWEITAILING、CHUANCICISHU、ZHIGUANSHIJIAN、DAOGUANYIWEIHESHENXUECIJIJUNSHIJINGMAIYANDEYOUFAYINSU。

                          3.1.3、导管异位

                        棋牌大全下载安装   PICCJIFAXINGYIWEIMEIYOUMINGQUEDEDINGYI,MUQIANLINCHUANGZHUYAOSHIZHIDAOGUANLIUZHIQIJIAN,JIANDUANYIWEIDAOQIANGJINGMAIYIWAIDEWEIZHI[13],SHIPICCLIUZHIQIJIANJIAOWEICHANGJIANDEBINGFAZHENGZHIYI[14].DAOGUANYIWEIDEFASHENGCHANGYUCHUANCIGUOCHENGZHONGZHITIGUODUWAIZHAN,HUOZHEZHIGUANHOUZHITIHUODONGGUODAYOUGUAN。BENYANJIU4LIDAOGUANYIWEIJUNWEISHANGZHIFASHENG,CHENXIAOCHUNDENG[15]HESUNCUIMEIDENG[16]YANJIUYEFAXIANJINGSHANGZHIJINGMAILIUZHIPICCDAOGUANDEYIWEILVMINGXIANGAOYUXIAZHIJINGMAI,KAOLVYUANYINYUJINGMAIZOUXINGXIANGGUAN,JINGSHANGZHIJINGMAIHUIRUSHANGQIANGJINGMAIDEFENZHIDUOQIEJIAODUXIAO,RONGYIWURUJINGJINGMAIHUOFANZHEZHIYEJINGMAI,ERXIAZHIJINGMAIFENZHISHAOQIEJIAOZHI,GUYIWEILVDI。TONGSHI,BENYANJIUZHONG4LIDAOGUANYIWEIYOU2LIJUNCONGTOUJINGMAIZHIRU,ERGNANNTDENG[17]RENWEI,SHANGZHIYUNDONGSHITOUJINGMAIZHIRUDEDAOGUANXIANGJIAOQITAJINGMAIZHIRUDEDAOGUAN,MODUANYIDONGJULISHAO,FASHENGDAOGUANYIWEISHAO。BENYANJIUZHONG,ZAOCHANERSHENGAO、TIZHILIANGZENGZHANGGUOKUAI,KENENGDAOZHITOUJINGMAIDEDAOGUANYIWEIYOUSUOZENGJIA。

                          3.2 、非计划性拔管的高危因素

                        棋牌大全下载安装   BENYANJIUJIEGUOXIANSHITAILINGYUEXIAO,CHUSHENGTIZHILIANGYUEQINGDEXIAOZAOCHANER,FEIJIHUAXINGBAGUANDEFENGXIANMINGXIANZENGGAO。CHENGSHUDUYUEDIDEXINSHENGER,QIMIANYILIYUEDIXIA,RONGYIFASHENGDAOGUANXIANGGUANXINGGANRAN。TONGSHI,GENGXIAODEZAOCHANERXUYAOSHUZHUJINGMAIYINGYANG、BINGZHONGQIUDANBAI、GAIJIDENGCIJIXINGYAOWUDEJIHUIGENGGAO,JIASHANGQIGUANQIANGGENGXIAO,XUEGUANBIBO,YINCIGENGRONGYIFASHENGXUEGUANBISUNSHANG,DAOZHIXUEGUANDUSAI[18]。TONGSHIFAXIANZHENJINGANFUCUOSHIDEYINGYONGZAIFEIJIHUAXINGBAGUANZHONGMINGXIANJIANSHAO,KAOLVCAIQUZHENJINGANFUCUOSHIKEYITIGAOYICIXINGZHIGUANCHENGGONGLV,JIANSHAOFANFUCHUANCIDUIPIFUJIXUEGUANDESUNSHANG[19,20],TONGSHIKENENGJIANSHAOHOUQISHIYONGGUOCHENGZHONGHUANERZHITIHUODONG,JIANGDIDAOGUANYIWEI、HUATUODENGBULIANGFANYINGDEFASHENG。DANZAILINCHUANGGONGZUOZHONG,YOUYUBUFENJIASHUJUJUESHIYONGZHENJINGJI、YIHURENYUANZHUGUANSHANGBUZHONGSHI、LINCHUANGGONGZUOFANMANGDENGYINSU,BUFENHUANERWEIDEDAOSHIDANGDEZHENJINGANFUCHULI,XUYINQIGAODUZHONGSHI。

                        棋牌大全下载安装   PICCWEIXINSHENGER,YOUQISHIXUZHANGQIZHUYUANDEZAOCHANERTIGONGLEANQUANKEKAODEJINGMAIYONGYAOTUJING。BENYUANSHOUZHIWEIZHONGXINSHENGERSHULIANGDUO,PICCZHIGUANLIANGDA,WEIXITONGFENXIPICCFEIJIHUAXINGBAGUANDEYUANYINJIGAOWEIYINSUTIGONGLETIAOJIAN。JIYUBENYANJIUDEJIEGUO,KEWEILINCHUANGGAISHANPICCGUANLITIGONGZHONGYAOCANKAO,JUYOUYIDINGDELINCHUANGYIYI。DANBENYANJIUWEIHUIGUXINGYANJIU,WUFAYOUXIAOBIMIANGANRAOYINSU,QIEFEIJIHUAXINGBAGUANDEYANGBENLIANGRENGQIANQUE。HOUQI,JIANGKEXUEYOUXIAODEGUANLIMOSHIHEGUANJIANHUANJIEDEKONGZHIZUOWEIXIAYIBUYANJIUDEFANGXIANG,LIQIUJIANGDIFEIJIHUAXINGBAGUANLV,TIGAOYILIAOANQUANYUZHILIANG。

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