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目的探讨中心静脉置管(CVC)在肿瘤内科的应用及其临床价值。方法肿瘤内科2000年7月31日至2013年7月31日住院患者3 859例,男性2 320例,女性1 539例;年龄14~88岁,中位年龄58岁;非小细胞肺癌、食管癌、胃癌、乳腺癌、贲门癌、结直肠癌、恶性淋巴瘤、宫颈癌、卵巢癌、鼻咽癌等51种肿瘤中晚期患者,及15种不同的双重癌患者,均采用经锁骨下穿刺将中心静脉导管置于上腔静脉末端,用于静脉给药。结果经锁骨下穿刺将中心静脉导管置于上腔静脉末端。结果共穿刺3 888例,置管成功3 859例(99.25%),其中右侧3 643例,左侧216例。置入单腔导管3 457例、双腔导管402例。(1)满足多种药物给药的特殊需求3 791例(98.24%):①13种抗癌药物及5种其他药物以便携式微量泵持续静脉输注(civ)22~24 h 1 290例(34.43%);②2种抗癌药物civ 8 h 10例(0.26%);③4种抗癌药物按最佳时辰civ 12 h1 369例(37.32%);④6种抗癌药物持续滴注4~24 h 49例(1.27%);⑤17种抗癌药物滴注或推注,为避免静脉的刺激及静脉炎的发生859例(22.21%);⑥5种高渗性或黏稠度高的药物较长时间滴注,为避免外周静脉刺激、反复穿刺及便于改善滴速117例(3.03%);⑦1种抗癌药物固定速率输注37例(0.96%)。(2)肺癌和肺部转移癌553例(14.33%):为保持肺部化疗药物的持续及峰浓度。(3)外周静脉条件差580例(15.03%):难以顺利给药者。(4)支持疗法较长期输液者454例(11.76%)。(5)多程化疗为避免外周静脉反复穿刺或既往有静脉炎史、患者要求70例(1.81%)。(6)抢救给药及快速输液所需4例(0.10%)。(7)外周静脉留置针失败者3例(0.08%)。(8)经外周静脉置入中心静脉导管(PICC)失败和PICC并发症不能使用者各2例(0.05%)。(9)神志恍惚、四肢躁动无法外周静脉输液者和供镇痛泵使用者各1例(0.03%)。所有需求均获满足。结论经锁骨下CVC在肿瘤内科用途甚广,其价值不仅可避免化疗药对外周静脉的刺激和用于civ化疗,而且可满足肿瘤内科治疗的多种特殊需求,为该科不可替代的必备技术。
Objective To investigate the application of central venous catheter (CVC) in oncology and its clinical value. Methods Tumor Oncology 3 859 hospitalized patients were enrolled from July 31, 2000 to July 31, 2013, with 2 320 males and 1 539 females. The patients were 14 to 88 years old with a median age of 58 years. Non-small cell lung cancer, Fifty-one patients with advanced cancer, including cancer, gastric cancer, breast cancer, cardia cancer, colorectal cancer, malignant lymphoma, cervical cancer, ovarian cancer and nasopharyngeal cancer, and 15 different double cancer patients were treated with subclavian puncture A central venous catheter is placed at the end of the superior vena cava for intravenous administration. Results The subclavian puncture placed the central venous catheter on the superior vena cava. Results A total of 3888 cases were punctured, and 3 859 cases (99.25%) were successful in catheterization, including 3 643 on the right and 216 on the left. There were 3 457 single-lumen catheters and 402 double-lumen catheters. (1) 3 791 cases (98.24%) were satisfied with the special needs of multiple drug administration: ①13 kinds of anticancer drugs and 5 kinds of other drugs were given by portable micro-pump continuous intravenous infusion (civ) 22 ~ 24 h 1 290 cases (34.43 %); ② 2 kinds of anticancer drugs civ 8 h 10 cases (0.26%); ③ 4 kinds of anticancer drugs according to the best hour civ 12 h1 369 cases (37.32%); ④ 6 kinds of anticancer drugs continued infusion of 4 ~ 24 h 49 (1.27%); ⑤17 kinds of anticancer drugs instillation or bolus, in order to avoid the occurrence of venous irritation and phlebitis in 859 cases (22.21%); ⑥ 5 kinds of hypertonic or high viscosity drugs longer infusion In order to avoid peripheral venous stimulation, repeated puncture and to improve the drip rate in 117 cases (3.03%); ⑦ a fixed rate infusion of anticancer drugs in 37 cases (0.96%). (2) 553 cases of lung cancer and metastatic lung cancer (14.33%): To maintain the sustained and peak concentration of pulmonary chemotherapy drugs. (3) 580 cases of poor peripheral vein conditions (15.03%): difficult to administer successfully. (4) 454 cases (11.76%) were treated with long-term infusion therapy. (5) Multistep chemotherapy In order to avoid repeated puncture of the peripheral vein or previous history of phlebitis, 70 patients (1.81%) were required. (6) 4 cases (0.10%) needed for salvage administration and rapid infusion. (7) Peripheral venous indwelling needle failure in 3 cases (0.08%). (8) Peripheral venous catheterization (PICC) failed and 2 patients (0.05%) each failed to treat PICC. (9) 1 case (0.03%) of trance, agitated limb peripheral venous fluid and analgesic pump users. All needs are met. Conclusion The subclavian CVC is widely used in oncology, its value not only can avoid the stimulation of peripheral vein and chemotherapy for civ, but also can meet the special needs of the medical treatment of the tumor, which is an indispensable necessity for the department technology.