微量肝素钠配伍营养液持续静脉输注在新生儿PICC置管后导管维护中的应用

郭娟 魏婷 曹娟 彭丽媛 龙小红

[摘要]目的 探讨微量肝素钠配伍营养液持续静脉输注在新生儿PICC置管后导管维护中的应用效果。方法 选取2016年7月～2017年6月我院收治的84例PICC置管新生儿为研究对象，随机将所有置管的新生儿分为对照组和观察组，每组42例。两组新生儿均给予静脉滴注营养液，观察组新生儿在每毫升营养液的基础上加用0.5 U肝素钠进行连续静脉滴注。比较两组导管阻塞、细菌定植及导管相关血流感染的发生率。测定凝血酶原时间（ PT ）、活化部分凝血酶原时间（ APTT ）、凝血酶时间（ TT ）和血小板计数（ PLT ），评价肝素钠配伍的安全性。结果 观察组新生儿导管堵塞发生率、导管内细菌定植发生率、导管相关血流感染发生率均显著低于对照组，差异有统计学意义（P<0.05）；两组新生儿凝血功能指标的比较，差异均无统计学意义（P>0.05）。结论 微量肝素钠配伍营养液持续静脉输注可有效降低新生儿PICC置管后导管堵塞、管内细菌定植和导管相关血流感染发生，同时不会对新生儿凝血功能，安全可靠。

[关键词]微量肝素钠；新生儿；中心静脉置管；导管维护；凝血功能

[中图分类号] R473 [文献标识码] A [文章编号] 1674-4721（2018）5（a）-0126-04

[Abstract]Objective To discuss the effect of micro-heparin sodium combined with total nutrient admixture in preventing catheter occlusion after PICC.Methods From 2016 to June 2017，84 neonates with PICC catheter were selected as the research object.All the newborns were randomly divided into control group and observation group，42 cases in each group.Two groups of newborns were given intravenous infusion of nutrient solution，the observation group of newborns on the basis of each ml of nutrient solution added 0.5 U heparin sodium for continuous intravenous drip.The incidence of catheter occlusion，bacterial colonization and catheter-related bloodstream infection were compared between the two groups. prothrombin time（PT），activated partial prothrombin time（APTT），thrombin time（TT）and platelet count（PLT）were measured to evaluate the safety of heparin sodium compatibility.Results The incidence of catheter blockage，bacterial colonization and catheter-related bloodstream infection in the observation group were significantly lower than those in the control group（P<0.05）.There was no significant difference in coagulation function between the two groups（P>0.05）.Conclusion The compatibility of trace heparin sodium combined with total nutrient admixture continuous intravenous infusion can effectively reduce the neonatal PICC catheter tube blockage，bacterial colonization and catheter-related bloodstream infection，while not on the coagulation function in the neonates is safe and reliable.

[Key words]Micro-heparin sodium；Newborns；Peripherally inserted central catheter（PICC）；Catheter maintenance； Coagulation function

营养供给对于新生儿、早产儿、极低出生体重儿非常重要，经外周导入中心静脉置管（peripherally inserted central catheter，PICC）是新生儿长期营养供应的有效途径之一。新生兒由于血管发育尚不成熟，其静脉血管管壁较薄、管腔较细、弹性纤维也较少，因此对局部注射药物的耐受性较差[1]。临床应用结果表明，PICC可以在体内长时间保留，降低了反复穿刺给新生儿皮肤、血管造成的损伤，增强了新生儿治疗的依从性和耐受性[2-3]。……