目的 探讨经上臂高位隧道式外周静脉穿刺中心静脉置管（peripherally inserted central catheter, PICC）在血管通路困难老年患者中的应用效果，为提升穿刺成功率提供临床依据。方法 2021年1-10月，采用便利抽样法选取在某院行超声引导下非隧道式PICC置管的老年血管通路困难患者43例为对照组，2021年11月至2022年8月，同法选取行超声引导下隧道式PICC置管的同类患者45例为观察组。比较两组患者术中情况、随访6个月期间PICC相关并发症及非计划拔管率。结果 在术中情况比较中，观察组有41例(91.11%)一针穿刺成功，高于对照组的27例(62.79%)，差异有统计学意义(P＜0.05)；而置管成功率、术中出血量、术后24 h渗血量差异均无统计学意义(均P＞0.05)。在随访6个月期间PICC相关并发症的比较中，观察组总并发症率为4.70%，低于对照组的13.33%，差异有统计学意义(P=0.007)。观察组非计划拔管率为2.30%，低于对照组的17.90%，差异有统计学意义（P=0.045）。结论 对于血管通路困难老年患者，经上臂高位隧道式PICC置管，可以提高一针穿刺成功率，维护方便，可降低导管滑脱率、减少非计划拔管及总并发症率。

Objective To explore the application effect of tunnel peripherally inserted central catheter(PICC) in elder patients with vascular access difficulties through upper arm,and to provide clinical basis for improving the success rate of puncture. Methods From January to October 2021,43 elder patients with vascular access difficulties undergoing ultrasound-guided non-tunnel PICC catheterizationin in a hospital were selected by convenience sampling method as the control group,and 45 patients of the same type undergoing ultrasound-guided tunnel PICC catheterization were selected as the observation group fromNovember 2021 to August 2022 by the same method.The intraoperative situation,PICC-related complications and unplanned extubationrate were compared between the two groups during 6-months follow-up. Results In the intraoperative comparison,41 cases(91.11%) in the observation group were successfully pierced with one needle,which was higher than that in the control group[27(62.79%)], the difference was statistically significant(P＜0.05).There were no significant differences in the success rate of catheterization,intraoperative blood loss and 24 h postoperative blood infiltration(all P＞0.05).In the comparison of PICC-related complications during 6-month follow-up, the total complication rate in the observation group was 4.70%, lower than 13.33% in the control group,and the difference was statistically significant(P=0.007).The rate of unplanned extubation in the observation group was 2.30%, lower than 17.90% in the control group, and the difference was statistically significant(P=0.045). Conclusions For elder patients with vascular access difficulties,high tunnel PICC catheterization through upper arm can improve the success rate of one-needle puncture,facilitate maintenance,and reduce the rate of catheter slip,unplanned extubation and total complications.

R472;R823

军队后勤面上项目(CEP21L002)