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极低/超低出生体质量儿经外周静脉穿刺中心静脉置管过程中发生机械性静脉炎的影响因素分析

Influencing factors of mechanical phlebitis in very/extremely low birth weight infants with peripherally inserted central catheterization

    摘要
  • 摘要:
    目的 分析新生儿重症监护室（NICU）极低/超低出生体质量儿（VLBWI/ELBWI）经外周静脉穿刺中心静脉置管术（PICC）过程中发生机械性静脉炎（MP）的影响因素。
    方法 回顾性分析行PICC的VLBWI/ELBWI的临床资料，采用多因素Logistic回归模型分析PICC后发生MP的影响因素。
    结果 VLBWI/ELBWI行PICC后，MP的发生率为26.1%（116/444）。单因素分析结果显示，导管尖端位置、置管静脉、出生胎龄、出生体质量、置管时胎龄、置管时体质量、穿刺次数、置入长度是VLBWI/ELBWI行PICC后发生MP的影响因素（P < 0.05）。多因素Logistic回归分析显示，PICC导管尖端位置异常（OR=2.526，95%CI：1.532~4.164）及穿刺次数≥2次（OR=1.952，95%CI：1.017~3.747）是VLBWI/ELBWI发生MP的独立危险因素。
    结论 导管尖端位置异常、穿刺次数≥2次会增高VLBWI/ELBWI行PICC后发生MP的风险。因此，临床医护人员应尽早采取措施加以预防，以减轻患儿痛苦，提升临床护理质量。

     

    Abstract:
    Objective To analyze the influencing factors of mechanical phlebitis (MP) during peripherally inserted central catheterization(PICC)in very/extremely low birth weight infants(VLBWI/ELBWI)in neonatal Intensive Care Unit (NICU).
    Methods The clinical data of VLBWI/ELBWI who underwent PICC catheterization were retrospectively analyzed. Multivariate Logistic regression model was used to analyze the influencing factors of MP.
    Results The incidence of MP after implementation of PICC in VLBWI/ELBWI was 26.1% (116/444). Univariate analysis showed that the position of catheter tip, catheter vein, gestational age, body mass at birth, gestational age when cathetering, body mass when cathetering, puncture times and length were influencing factors for MP in VLBWI/ELBWI (P < 0.05). Multivariate Logistic regression analysis showed that abnormal position ofcatheter tip (OR=2.526; 95%CI, 1.532 to 4.164) and puncture times ≥ 2 times (OR=1.952; 95%CI, 1.017 to 3.747) were independent risk factors.
    Conclusion The abnormal catheter tip position and the number of puncturing ≥ 2 times increase the risk of mechanical phlebitis in VLBWI/ELBWI after PICC. Early intervention should be taken as soon as possible to avoid the occurrence of MP so as to relieve infants'pain and improve the quality of clinical care.

     

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