王玲

[摘要] 目的 探讨高龄老年患者采用超声引导下塞丁格（Seldinger）置入PICC的效果。 方法 对100例高龄老年患者随机分成观察组和对照组，各50例。对照组行传统置管方法，观察组采用超声引导下Seldinger置入方法，观察两组患者一次穿刺成功率、一次置管成功率、术后穿刺点出血率、2周内静脉炎发生率、置管留置时间、患者置管后的满意度比较。 结果 观察组患者一次穿刺成功率、一次置管成功率均高于对照组；术后穿刺点出血率、2周内静脉炎发生率均低于对照组；患者置管后的满意度高于对照组，差异有统计学意义（P<0.05），平均留置时间观察组长于对照组。 结论 超声引导下的Seldinger技术置入PICC成功率高，并发症少，留置时间长，安全性好，患者满意度高，是高龄老年患者首选的穿刺方法。

[关键词] 高龄老年患者；超声引导Seldinger技术；PICC置管；并发症

[中图分类号] R592 [文献标识码] A [文章编号] 1674-4721（2016）02（c）-0158-03

[Abstract] Objective To explore the advantages of using ultrasonic guided Seldinger insert PICC for elderly patients. Methods 100 elderly patients were randomly divided into observation group and control group，and each group was 50 cases.Patients in control group were used traditional catheter method，and patients in observation group were used ultrasonic guided plug Seldinger.Success rate of once puncture， success rate of once catheter，postoperative punctured hemorrhage rate，incidence rate of phlebitis within 2 weeks，catheter indwelling time and patients′ satisfaction after catheter in two groups were observed. Results Success rate of once puncture and success rate of once catheter in observation group were higher than that of control group；postoperative punctured hemorrhage rate and incidence rate of phlebitis within 2 weeks were lower than that of control group； patients′ satisfaction after catheter was higher than that of control group，and the difference was statistical significance （P<0.05）.Average catheter indwelling time in observation group was longer than that of control group. Conclusion Ultrasonic guided Seldinger technology for inserting PICC with high success rate，less complications，long indwelling time，good safety and high satisfaction.It is a preferred puncture method for elderly patients.

[Key words] Elderly patients；Ultrasonic guided Seldinger technology；PICC catheter；Complications

本科患者特点为高龄老年，多病共存，营养不良，需长时间静脉输液或静脉营养支持治疗，而老年患者血管弹性差，管壁硬化、脆性增加、管腔狭窄，且由于皮下脂肪的减少，皮下组织疏松血管易滚动，不易固定，造成静脉穿刺困难，置管不易保留，因此，本科近年来开展了经外周静脉置入中心静脉导管（peripherally inserted central catheter，PICC）技术，而对于肘部血管条件差的高龄老年患者，选取本科2012年10月～2014年10月采用经超声引导下Seldinger技术置入PICC，在高龄老年患者的治疗中取得良好效果。

1 资料与方法

1.1 一般资料

选取本科2012年10月～2014年10月因长期输液和静脉高营养治疗需行PICC置管的患者100例，男85例，女15例，年龄80～95岁，平均（84.73±3.24）岁，其主要疾病为脑血管疾病11例，呼吸系统疾病50例，肿瘤16例，心血管系统疾病18例，消化系统疾病5例。将患者随机分成观察组和对照组，各50例，两组在年龄、性别、病种、病情等方面比较，差异无统计学意义（P>0.05）。