超声引导下中心静脉置管失败的相关因素logistic回归分析
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摘要
目的:探讨超声引导下中心静脉置管失败的相关因素并进行logistic回归分析,以求降低其失败率。方法:回顾性分析2014年1月至2016年12月在超声引导下置入中心静脉导管的322例患者,分析导致置管失败的主要因素,并进行单因素分析及多因素logistic回归分析。结果:行超声引导下中心静脉置管的322例患者,首次置管成功者262例(81.37%),失败者60例(18.63%);单因素分析结果:性别、年龄、血管直径、血管部位、肢体有无水肿、体位、操作者工作年限、置管前有无知识宣教与心理护理等8个因素均与超声引导下中心静脉置管失败有关(P<0.05); logistic回归分析结果:性别、血管直径、血管部位、体位等因素是导致超声引导下中心静脉置管失败的危险因素(P<0.05)。结论:超声引导下中心静脉置管有一定失败率,且影响静脉置管失败因素较多,因此应采取针对性措施进行预防与纠正,提高超声引导下中心静脉置管成功率。
Objective: To explore the factors associated with failure of central venous catheterization under ultrasound guidance and to conduct logistic regression analysis in order to reduce its failure rate. Methods:A retrospective analysis of 322 patients with central venous catheterization under ultrasound guidance from January 2014 to December 2016 was conducted' The main factors that lead to the failure of the catheterization were analyzed,and the single factor analysis and multivariate logistic regression analysis were performed. Results:(1) In the 322 patients who underwent central venous catheterization under ultrasound guidance,262 patients(81.37%) had successful initial catheterization,and 60 patients(18.63%) were failed.(2) The results of single factor analysis showed that 8 factors including sex,age,blood vessel diameter,vascular location,edema,position,operator's working life,knowledge education and mental nursing before catheterization were all related to the failure of ultrasound guided central venous catheterization(P <0.05).(3) Logistic regression analysis showed that the factors such as sex,blood vessel diameter,vascular location,position and other factors were the risk factors for the failure of the central venous catheterization under ultrasound guidance(P <0.05). Conclusion: Ultrasound guided central venous catheterization has a certain failure rate,there are many factors affecting the failure of venous catheterization. Therefore,pertinent measures should be taken to prevent and correct so as to improve the success rate of central venous catheterization under ultrasound guidance.
Objective: To explore the factors associated with failure of central venous catheterization under ultrasound guidance and to conduct logistic regression analysis in order to reduce its failure rate. Methods:A retrospective analysis of 322 patients with central venous catheterization under ultrasound guidance from January 2014 to December 2016 was conducted' The main factors that lead to the failure of the catheterization were analyzed,and the single factor analysis and multivariate logistic regression analysis were performed. Results:(1) In the 322 patients who underwent central venous catheterization under ultrasound guidance,262 patients(81.37%) had successful initial catheterization,and 60 patients(18.63%) were failed.(2) The results of single factor analysis showed that 8 factors including sex,age,blood vessel diameter,vascular location,edema,position,operator's working life,knowledge education and mental nursing before catheterization were all related to the failure of ultrasound guided central venous catheterization(P <0.05).(3) Logistic regression analysis showed that the factors such as sex,blood vessel diameter,vascular location,position and other factors were the risk factors for the failure of the central venous catheterization under ultrasound guidance(P <0.05). Conclusion: Ultrasound guided central venous catheterization has a certain failure rate,there are many factors affecting the failure of venous catheterization. Therefore,pertinent measures should be taken to prevent and correct so as to improve the success rate of central venous catheterization under ultrasound guidance.
引文
[1] Kim E H,Lee J H,Song I K,et al. Influence of caudal traction of ipsilateral arm on ultrasound image for supraclavicular central venous catheterization[J]. American Journal of Emergency Medicine,2016,34(5):851~855.
[2] Soni N J,Reyes L F,Keyt H,et al. Use of ultrasound guidance for central venous catheterization:a national survey of intensivists and hospitalists.[J]. Journal of Critical Care,2016,36(7):277~283.
[3]黄翠红,陈秀梅,黄翠娟,等.植入式静脉输液港与经外周中心静脉置管在化疗患者中的应用效果比较[J].广东医学,2016,37(3):472~473.
[4]陶红蕾,姜云峰,王冬冬,等.超声引导下行锁骨下静脉穿刺置入中心静脉导管的效果分析[J].中国消毒学杂志,2016,33(7):708~710.
[5] Mcgraw R,Chaplin T,Mckaigney C,et al. Development and evaluation of a simulation-based curriculum for ultrasound-guided central venous catheterization[J]. Canadian Journal of Emergency Medicine,2016,18(6):405~413.
[6] Hoffman T,Du P M,Prekupec M P,et al. Ultrasoundguided central venous catheterization:a review of the relevant anatomy,technique,complications and anatomical variations[J]. Clinical Anatomy,2016,30(2):237~250.
[7]黄雪敏,李大亮.超声引导下中心静脉穿刺置管术的研究进展[J].中国医药导报,2016,13(17):36~40.
[8]杨柳,李萍,王花.超声引导在危重症患者中心静脉穿刺置管中的应用[J].生物医学工程与临床,2017,21(05):499~501.
[9] Buzana Ais G,Roger C,Bastide S,et al. Comparison of two ultrasound guided approaches for axillary vein catheterization:a randomized controlled non-inferiority trial[J]. Br Anaesth,2016,116(2):215~222.
[10]彭小华,冯婷,胡晓梅,等.经外周静脉置入中心静脉导管患者首次穿刺失败的原因分析[J].华西医学,2016,31(04):619~621.
[11]白国欣,姜雪莲,高平,等.持续CVP监测老年患者中心静脉导管堵塞的原因及对策[J].河北医药,2016,38(12):1904~1906.
[12]沈定玉,陶利群,陈雪珍,等.护理干预对经外周静脉穿刺置入中心静脉导管置管成功率的影响[J].全科护理,2010,8(9):765~766.
[13]徐云美,姚丽萍,吕晓军,等.超声引导下贵要静脉穿刺在经外周穿刺中心静脉导管置管术中的应用价值[J].中国超声医学杂志,2017,33(6):571~573.
[14]万红,齐颖,林筱,等.外周穿刺中心静脉导管不同置管方式在新生儿中的应用[J].实用临床医药杂志,2016,20(6):188~189.
[15]熊李燕,卢谷萍,王小园.超声引导下PICC置管成功率影响因素非条件Logistic回归分析[J].宜春学院学报,2015,37(12):69~71.
[2] Soni N J,Reyes L F,Keyt H,et al. Use of ultrasound guidance for central venous catheterization:a national survey of intensivists and hospitalists.[J]. Journal of Critical Care,2016,36(7):277~283.
[3]黄翠红,陈秀梅,黄翠娟,等.植入式静脉输液港与经外周中心静脉置管在化疗患者中的应用效果比较[J].广东医学,2016,37(3):472~473.
[4]陶红蕾,姜云峰,王冬冬,等.超声引导下行锁骨下静脉穿刺置入中心静脉导管的效果分析[J].中国消毒学杂志,2016,33(7):708~710.
[5] Mcgraw R,Chaplin T,Mckaigney C,et al. Development and evaluation of a simulation-based curriculum for ultrasound-guided central venous catheterization[J]. Canadian Journal of Emergency Medicine,2016,18(6):405~413.
[6] Hoffman T,Du P M,Prekupec M P,et al. Ultrasoundguided central venous catheterization:a review of the relevant anatomy,technique,complications and anatomical variations[J]. Clinical Anatomy,2016,30(2):237~250.
[7]黄雪敏,李大亮.超声引导下中心静脉穿刺置管术的研究进展[J].中国医药导报,2016,13(17):36~40.
[8]杨柳,李萍,王花.超声引导在危重症患者中心静脉穿刺置管中的应用[J].生物医学工程与临床,2017,21(05):499~501.
[9] Buzana Ais G,Roger C,Bastide S,et al. Comparison of two ultrasound guided approaches for axillary vein catheterization:a randomized controlled non-inferiority trial[J]. Br Anaesth,2016,116(2):215~222.
[10]彭小华,冯婷,胡晓梅,等.经外周静脉置入中心静脉导管患者首次穿刺失败的原因分析[J].华西医学,2016,31(04):619~621.
[11]白国欣,姜雪莲,高平,等.持续CVP监测老年患者中心静脉导管堵塞的原因及对策[J].河北医药,2016,38(12):1904~1906.
[12]沈定玉,陶利群,陈雪珍,等.护理干预对经外周静脉穿刺置入中心静脉导管置管成功率的影响[J].全科护理,2010,8(9):765~766.
[13]徐云美,姚丽萍,吕晓军,等.超声引导下贵要静脉穿刺在经外周穿刺中心静脉导管置管术中的应用价值[J].中国超声医学杂志,2017,33(6):571~573.
[14]万红,齐颖,林筱,等.外周穿刺中心静脉导管不同置管方式在新生儿中的应用[J].实用临床医药杂志,2016,20(6):188~189.
[15]熊李燕,卢谷萍,王小园.超声引导下PICC置管成功率影响因素非条件Logistic回归分析[J].宜春学院学报,2015,37(12):69~71.