程实 苏红利 王宁 祖秀娴

【摘要】 目的：比较重度营养不良患者经贵要静脉与肱静脉行超声引导下PICC置管的效果。方法：选取2016年3月-2019年3月于本院静脉输液治疗的重度营养不良患者263例的临床资料进行回顾性分析，两组均行超声引导下行PICC置管，其中122例经贵要静脉置管者作为贵要静脉组，141例经肱静脉置管者作为肱静脉组，比较两组置管情况及置管后并发症发生情况。结果：肱静脉组一次穿刺置管成功率为97.9%高于贵要静脉组的84.4%，差异有统计学意义（P<0.05）;两组总置管成功率及异常拔管率比较，差异均无统计学意义（P>0.05）。肱静脉组置管后并发症发生率低于贵要静脉组，差异有统计学意义（P<0.05）。结论：在重度营养不良患者超声引导下经肱静脉一次穿刺置入PICC导管成功率更高，并发症少，可作为首选。

【关键词】 重度营养不良 贵要静脉 肱静脉 PICC 超声引导

Comparison of the Effect of Ultrasonic-guided PICC Catheterization in Patients with Severe Malnutrition through the Basilic Vein and Brachial Vein/CHENG Shi， SU Hongli， WANG Ning， ZU Xiuxian. //Medical Innovation of China， 2021， 18（13）： 0-089

[Abstract] Objective： To compare the effect of ultrasonic-guided PICC catheterization through basilic vein and brachial vein in patients with severe malnutrition. Method： The clinical data of 263 cases of severe malnutrition patients who received intravenous infusion in our hospital from March 2016 to March 2019 were retrospectively analyzed. Both groups received ultrasonic-guided PICC catheterization， among which 122 cases of catheterization through the basilic vein were included in the basilic vein group， and 141 cases of catheterization through the brachial vein were included in the brachial vein group. The catheterization situation incidence of complications after catheterization were compared between the two groups. Result： The success rate of one puncture and catheterization in the brachial vein group was 97.9%， which was higher than 84.4% in the basilic vein group， and the difference was statistically significant （P<0.05）. There were no statistical significance in the success rate of total catheterization and the rate of abnormal extubation between the two groups （P>0.05）. The incidence of complications after catheterization in the brachial vein group was lower than that in the basilic vein group， and the difference was statistically significant （P<0.05）. Conclusion： In severe malnutrition patients， ultrasound-guided one-time PICC catheter placement through brachial vein has higher success rate and fewer complications， which can be used as the first choice.

[Key words] Severe malnutrition Basilic vein Brachial vein PICC Ultrasonic-guided

First-authors address： Beijing Fengtai Hospital， Beijing 100071， China

doi：10.3969/j.issn.1674-4985.2021.13.021

經外周静脉穿刺中心静脉置管术（peripherally inserted central catheter，PICC）操作简单、患者痛苦少、安全有效、维护方便而且留置时间长，目前已广泛应用于临床，对于长期静脉输液、肠外营养、恶性肿瘤化疗、危重症等患者有相当大的意义[1-2]。随着中国老龄化社会的到来，各种疾病相关的营养不良老年患者日益增多，尤其是重度营养不良患者的PICC置管过程中选择合适的血管尤为重要。为此，笔者回顾性分析了本院263例重度营养不良患者置管时的临床资料，比较超声引导下经不同静脉置入PICC导管的效果，现报道如下。

1 资料与方法

1.1 一般资料 选取2016年3月-2019年3月于本院静脉输液治疗的重度营养不良患者263例的临床资料进行回顾性分析。纳入标准：置管前采用NRS2002评分量表行营养筛查，评分均大于7分，存在重度营养不良[1];营养状况指……