【作者】 陈桂英；

【导师】 王惠琴；

【作者基本信息】 浙江大学 ， 护理学， 2012， 硕士

【摘要】 研究目的通过使用40ml浓度0.125mg/ml地塞米松溶液预处理PICC(Peripherally Inserted Central Catheter)导管,探讨地塞米松溶液对PICC所致静脉炎有无预防作用、有无降低PICC所致静脉炎严重程度的作用、有无延缓PICC所致静脉炎发生时间的作用、有无预防其它PICC早期并发症的作用。探讨一些相关因素,为预防和治疗PICC所致静脉炎提供科学依据。研究方法选择873例置入PICC的住院患者,随机分成试验组441例和对照组432例。两组均用标准操作程序置入PICC,在预处理导管时试验组使用0.125mg/ml地塞米松溶液40ml,浸泡时间3min～20min；对照组使用40ml生理盐水,浸泡时间3min～20min。比较两组静脉炎的发生率、发生时间、严重程度和其他早期并发症等指标。探讨地塞米松溶液对PICC所致静脉炎有无预防作用,寻找相关的影响因素。研究结果1.地塞米松溶液预处理导管组PICC所致静脉炎的发生率为6.3%,生理盐水预处理导管组PICC所致静脉炎的发生率为13.4%,差异有统计学意义(P<0.05).且试验组静脉炎的Ⅲ级和Ⅳ级静脉炎的发生率均少于对照组,差异有统计学意义(P<0.05)。2.地塞米松溶液预处理导管组静脉炎发生时间的中位数分布在置管后49～72h,生理盐水预处理导管组静脉炎发生时间的中位数分布在置管后24～48h内,试验组静脉炎的发生时间晚于对照组(P<0.05)。3.地塞米松溶液预处理导管组和生理盐水预处理导管组其他并发症的发生率无差异(P>0.05)4.地塞米松溶液预处理导管组和生理盐水预处理导管组均无药物不良反应发生。5.穿刺方式、置管尝试次数与PICC所致的静脉炎发生与否有关(P<0.05)。结论140ml浓度0.125mg/ml地塞米松溶液预处理PICC导管对PICC所致静脉炎有预防作用。240ml浓度0.125mg/ml地塞米松溶液预处理PICC导管有延迟PICC所致静脉炎发生的作用。340ml浓度0.125mg/ml地塞米松溶液预处理PICC导管对PICC所致的其它早期并发症无明显预防作用。4.减少置管尝试次数、使用B超引导下穿刺可减少PICC所致的机械性静脉炎发生的可能性。更多还原

【Abstract】 ObjectiveThe objective of this study is exploring whether Dexamethasone solution can prevent, mitigate, or delay PICC-associated phlebitis by using40ml0.125mg/ml Dexamethasone solution to handle PICC catheter; To explore the impact of patients’ basic data related to PICC so as to provide scientific basis for preventing PICC-associated phlebitis.MethodsA randomized, double-blind, placebo-controlled clinical trial was conducted.873hospitalized patients receiving PICC were randomly divided into two groups. The patients of both two groups were inserted PICC by standard procedure. The441patients in the experimental group used40ml0.125mg/ml dexamethasone solution to dip in the catheters. While the432patients in the control group used40ml normal saline to dip in the catheters. The dipping time of both groups is no less than3mins, no more than20mins. Using the standard from Infusion Nursing Society determine and evaluate the phlebitis once per day till7days after inserting the catheter. Compare the incidence of phlebitis, the accuring time of phlebitis and the severity of phlebitis and also other complications. To explore whether Dexamethasone solution can prevent PICC-associated phlebitis or not, and searched for other related factorsResults1. The incidence of phlebitis of experimental group was6.3%, while the incidence of phlebitis of the control group was13.4%, with significant difference (P<0.05). The incidence of Ⅲ and Ⅳ degree phlebitis of experimental are less than those in the control group, with significant difference (P<0.05)2. The median occurrence time of phlebitis of experimental group is49～72hours after inserting the catheter; while the median occurrence time of phlebitis of control group is25～48hours after inserting the catheter (P<0.05).3. With respect to other complications, there were no difference between the experimental group and control group (P>0.05).4. No adverse medical effects have been observed among the patients of both experimental group and control group.5. The inserting method and attemept inserting times have relation with whether the PICC-associated phlebitis will occur or not (P<0.05).Conclusion1. Dipping the catheters in40ml0.125mg/ml dexamethasone solution can reduce the incidence of PICC-associated phlebitis..2. Dipping the catheters in40ml0.125mg/ml dexamethasone solution can delay the coourance of PICC-associated phlebitis.3. There are no manifest impacts on other PICC-associated complications by dipping the catheters in40ml0.125mg/ml dexamethasone solution.4. Using the ultrasound-guided PICC placement and reducing the attemept inserting times can prevent the occurance of the PICC-associated phlebitis.更多还原