罗秀状等

[摘要] 目的 探讨锁骨下静脉穿刺置管术在乳腺癌化疗期的优越性，为临床应用提供参考。 方法 选择2011年4月～2014年4月入住右江民族医学院附属医院的乳腺癌根治术后需化疗患者196例，按手术根治部位及肘部静脉情况分为实验组及对照组；实验组经盲穿和（或）在血管减影引导下行锁骨下静脉置管132例；对照组经肘部静脉行中心静脉置管64例；术后观察两组置管成功率、导管相关感染、并发症发生率。 结果 两组首次穿刺成功率分别为94.6%及95.3%，差异无统计学意义（P > 0.05）；对照组术后并发导管相关性感染、静脉血栓并发症的例数较实验组多，组间比较差异有统计学意义（P < 0.05）。 结论 运用锁骨下静脉置管术用于乳腺癌术后化疗，具有穿刺成功率高、创伤小、严重并发症少，值得临床应用和推广。

[关键词] 锁骨下静脉置管术；乳腺肿瘤化疗；数字血管减影；优越性

[中图分类号] R737.9 [文献标识码] A [文章编号] 1673-7210（2015）02（b）-0036-04

[Abstract] Objective To investigate superiority of subclavian venepuncture in mammary cancer during chemotherapy， so as to provide reference for clinical application. Methods A total of 196 patiens who need chemotherapy after breast cancer radical surgery from April 2011 to April 2014 in Affiliated Hospital of Youjiang Medical University. According to the operation position and the elbow vascular conditions they were divided into two groups randomly， there were 132 patiens in the experiment group and 64 patients in the control group. The experiment group underwent subclavian venepuncture by blind wear or under the guidance of digital subtraction angiography （DSA）， while the control group underwent peripherally inserted central catheter （PICC） inserted from elbow vein. The rate of one-time puncture success， incidence of catheter-related infection and complications were observed and analyzed. Results The two groups showed no statistically significant difference in the rate of one-time puncture success （P > 0.05）. The rate of one-time puncture success was 96.85% in the control group and 95.93% in the experiment group. However， significant differences in the incidence of catheter-related infection and complications were found between the two groups（P < 0.05）. Conclusion Subclavian venepuncture under the guidance of DSA during chemotherapy after operation of breast cancer has the advantages of high success rate of puncture， less trauma and few complications， which is worthy of clinic application and promotion.

[Key words] Subclavian venepuncture； Breast tumor chemotherapy； DSA； Superiority

锁骨下静脉置管术是中心静脉置管术（central venous catheter，CVC）其中方法之一，是抢救患者、胃肠外营养、输注高浓度药物或是抗恶性肿瘤化疗等的一项重要的置管技术[1-2]。乳腺癌手术根治后需反复多次化疗已得到临床实践验证[3]。近十年来，右江民族医学院附属医院（以下简称“我院”）为了适应临床护理发展需求，逐步开展实施CVC、外周导入中心静脉置管术（peripherally inserted central catheter，PICC）用于临床治疗中，如今可在数字血管减影引导下行锁骨下静脉置管，用于恶性肿瘤术后化疗，取得良好的治疗效果，从而降低了特殊用药对外周静脉损伤的风险[4]。随着静脉用药的安全及规范，我院静脉治疗小组针对PICC和CVC引发的不良因素进行分析，认为锁……