目的：探讨经外周静脉穿刺中心静脉置管术（ PICC）在早产儿的应用及常见并发症的处理。方法回顾性分析2011年10月至2013年6月期间西安交通大学医学院第一附属医院新生儿科重症监护室41例PICC早产儿的置管途径、置管成功率、置管长度、留管时间、并发症及处理方法。结果穿刺部位：肘正中静脉25例，贵要静脉11例，头臂静脉2例，颞浅静脉2例，髂外静脉1例；右侧置管35例，左侧置管6例；一次置管成功率为100％（41/41），置管长度7～12cm，留管时间3h～44d；29例正常拔管，2例导管异位，2例堵管拔管，3例外渗拔管，1例静脉炎，1例细菌培养阳性，2例葡聚糖升高拔管，1例有临床感染症状但细菌培养阴性。结论 PICC操作成功率高、安全、留置时间长，是早产儿较佳的静脉通道；肘正中静脉及贵要静脉是较佳的PICC静脉通路，头臂静脉、颞浅静脉及髂外静脉例数减少，但推测颞浅静脉不宜作为早产儿PICC的静脉通路。%Objective To explore the application of peripherally inserted central catheter (PICC) in premature and treatment of common complications .Methods Retrospective analysis was conducted on 41 premature infants with PICC between October 2011 and June 2013 in neonatal intensive care unit of First Affiliated Hospital of Xi ’ an Jiaotong University , including inserting pathways , success rate , length of tube, tube indwelling time, complications and treatment methods .Results Of 41 cases, 25 cases were inserted from median cubital vein , 11 cases from basilic vein , 2 cases from brachiocephalic vein , 2 cases from superficial temporal vein and 1 case from external iliac vein . There were 35 cases with catheter on right side and 6 cases on left side.The success rate was 100%(41/41), with length of 7-12 cm and tube indwelling time 3h-44d.Extubation of 29 cases were at recovery, and 2 cases underwent extubation for heterotopia , 2 cases for block, 3 cases for exceptional permeability , 1 case for phlebitis , 1 case for positive germiculture , 2 cases for glucan increasing , and 1 case for clinical symptoms of infection .Conclusion Because of high success rate , safety and long indwelling , PICC is an appropriate venous channel for premature .Median cubital vein and basilic vein are better venous pathway , and the cases with brachiocephalic vein , superficial temporal vein and superficial temporal vein decrease .We speculate that superficial temporal vein is not suitable for venous pathway .
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