经不同外周静脉导管采血在肥胖合并代谢综合征手术患者中的比较研究

doi:10.3761/j.issn.2096-7446.2025.01.001

摘要/Abstract

摘要：

目的比较3种不同长度的外周静脉导管用于肥胖合并代谢综合征手术患者采血的效果。方法采用定点连续抽样法，选取2023年4月—6月浙江省某三级甲等综合医院的住院患者作为研究对象。采用简单随机分组法将患者分为3组，试验组1经迷你中长导管采血，试验组2经中等长度导管采血，对照组经外周静脉留置针采血。比较3种导管采血总成功率、首次采血失败生存分析、首次采血成功率、标本合格率、导管相关并发症发生率。结果共纳入162例患者，每组54例。试验组1、试验组2和对照组的采血总成功率分别为53.70%、88.89%、31.48%，两两比较结果显示，试验组1和试验组2、试验组2和对照组比较，差异具有统计学意义（P<0.017），试验组1和对照组比较，差异无统计学意义（P>0.017）；试验组1、试验组2和对照组导管相关并发症总发生率分别为33.33%、14.81%、40.74%，差异具有统计学意义（P<0.05），两两比较结果显示，试验组2和对照组比较差异具有统计学意义（P<0.017），试验组1和试验组2、试验组1和对照组比较，差异无统计学意义（P>0.017）。关于发生首次采血失败的时间，试验组1和对照组分别为4.00（3.36，4.64）、3.00（2.25，3.75） d，3组比较，差异具有统计学意义（Log-Rank，P<0.001）。结论 3种外周静脉导管均可用于肥胖合并代谢综合征患者首次采血，其中经中等长度导管采血发生首次采血失败的时间晚、采血总成功率较高，导管相关并发症总发生率低。

关键词: 肥胖合并代谢综合征, 血管通路, 外周静脉导管, 采血, 护理

Abstract:

Objective To compare the effects of three different lengths of peripheral venous catheters for blood collection in surgical patients with obesity combined with metabolic syndrome. Methods The inpatients of a tertiary general hospital in Zhejiang Province from April 2023 to June 2023 were selected as the study subjects using the fixed-point consecutive sampling method. The patients were divided into three groups by simple randomized controlled method，with blood collection via a mini-midline catheter in experimental group 1，via midline catheter in experimental group 2，and peripheral venous indwelling needle in the control group. The overall success rate of blood collection，survival analysis of first blood collection failure，success rate of first blood collection，specimen qualification rate，and incidence of catheter-related complications were compared among the three groups. Results A total of 162 patients were included，with 54 patients in each group. The total success rates of blood collection in experimental group 1，experimental group 2 and control group were 53.70%，88.89%，and 31.48%，respectively. The results of two-by-two comparisons showed that the differences were statistically significant（P<0.017） when comparing experimental group 1 and experimental group 2，experimental group 2 and control group. The differences were not statistically significant（P>0.017） when comparing experimental group 1 and the control group. The total rates of catheter-related complications in experimental group 1，experimental group 2 and control group were 33.33%，14.81%，and 40.74%，respectively，and the difference was statistically significant（P<0.05）. A two-by-two comparison of the results showed that the difference between the experimental group 2 and control group was statistically significant（P<0.017） and there was no statistically significant difference comparing the experimental group 1 and experimental group 2，and experimental group 1 and control group（P>0.017）. Regarding the time of he first blood collection failure，it was 4.00（3.36，4.64） and 3.00（2.25，3.75） d for experimental group 1 and control group，respectively，and the difference was statistically significant when comparing the three groups（Log Rank，P<0.001）. Conclusion The three peripheral venous catheters can be used for the first blood collection in patients with obesity combined with metabolic syndrome. When collecting blood via a midline catheter，the time of first blood collection failure is later，the overall success rate of blood collection is higher，and overall incidence of catheter-related complications is lower.

Key words: Obesity Combined with Metabolic Syndrome, Vascular Access, Peripheral Intravenous Catheter, Blood Collection, Nursing Care

李祥云, 王洁, 刘畅, 陈家欣, 金蕾, 金奕, 曹秀珠, 赵林芳. 经不同外周静脉导管采血在肥胖合并代谢综合征手术患者中的比较研究[J]. 中华急危重症护理杂志, 2025, 6(1): 10-16.

LI Xiangyun, WANG Jie, LIU Chang, CHEN Jiaxin, JIN Lei, JIN Yi, CAO Xiuzhu, ZHAO Linfang. The comparison of blood collection via different peripheral venous catheters in surgical patients with obesity combined with metabolic syndrome[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(1): 10-16.

图/表 5

参考文献 23

[1]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)(下)[J]. 中国实用内科杂志, 2021,41(9) :757-784.
	Diabetes Branch of Chinese Medical Association. Guidelines for the Preventation and Treatment of Type 2 Diabates in China(2020 Edition)(Part 2)[J]. Chin J Pract Int Med, 2021, 41(9):757-784.
[2]	Abbasi MSP, Tousi AZ, Yazdani Y, et al. Dietary choline and betaine intake,cardio-metabolic risk factors and prevalence of metabolic syndrome among overweight and obese adults[J]. BMC Endocr Disord, 2023, 23(1):67.
[3]	Khidir N, El-Matbouly MA, Sargsyan D, et al. Five-year outcomes of laparoscopic sleeve gastrectomy:a comparison between adults and adolescents[J]. Obes Surg, 2018, 28(7):2040-2045.
[4]	王勇, 王存川, 朱晒红, 等. 中国肥胖及2型糖尿病外科治疗指南(2019版)[J]. 中国实用外科杂志, 2019, 39(4):301-306.
	Wang Y, Wang CC, Zhu SH, et al. Guidelines for surgical treatment of obesity and type 2 diabetes in China(2019 edition)[J]. Chin J Pract Surg, 2019, 39(4):301-306.
[5]	姚琪远, 许博. 减重代谢手术围手术期规范化管理[J]. 中国实用外科杂志, 2014, 34(11):1035-1038. doi: 10.7504/CJPS.ISSN1005-2208.2014.11.09
	Yao QY, Xu B. Standard perioperative management and follow-up of bariatric and metabolic surgery[J]. Chin J Pract Surg, 2014, 34(11):1035-1038.
[6]	Nickel B, Gorski L, Kleidon T, et al. Infusion therapy standards of practice,9th edition[J]. J Infus Nurs, 2024, 47(Suppl 1):S1-S285.
[7]	Tsukuda Y, Funakoshi T, Nasuhara Y, et al. Venipuncture nerve injuries in the upper extremity from more than 1 million procedures[J]. J Patient Saf, 2019, 15(4):299-301. doi: 10.1097/PTS.0000000000000264 pmid: 27314202
[8]	Marsh N, Larsen EN, O’Brien C, et al. Safety and efficacy of midline catheters versus peripheral intravenous catheters:a pilot randomized controlled trial[J]. Int J Nurs Pract, 2023, 29(2):e13110.
[9]	国家卫生健康委员会. 静脉血液标本采集指南:WS/T 661—2020[S]. 北京: 中国标准出版社, 2020.
	National Health Commission. Guidelines of venous blood specimen collection:WS/T 661—2020[S]. Beijing: Standards Press of China, 2020.
[10]	国家卫生健康委员会. 静脉治疗护理技术操作标准:WS/T 433—2023[S]. 2023.
	National Health Commission. Nursing practice standard for intravenous therapy:WS/T 433—2023[S]. 2023.
[11]	Psaila J, Parsons TF, Hahn SA, et al. Prospective study eval-uating whether standard peripheral intravenous catheters can be used for blood collection throughout hospital stay[J]. J Infus Nurs, 2023, 46(1):43-47.
[12]	李全磊, 颜美琼, 张晓菊, 等. 不同PICC导管对并发症发生影响的系统评价[J]. 中华护理杂志, 2013, 48(5):390-395.
	Li QL, Yan MQ, Zhang XJ, et al. The influence of different types of PICC lines on the incidence of complications:a systematic review[J]. Chin J Nurs, 2013, 48(5):390-395.
[13]	陈晓明, 陈雪花, 魏存, 等. 一针式皮下隧道穿刺法在改良型三向瓣膜中长导管中的应用[J]. 护理实践与研究, 2023, 20(2):290-293.
	Chen XM, Chen XH, Wei C, et al. Application of one-needle subcutaneous tunnel puncture in long catheter of improved three-way valve[J]. Nurs Pract Res, 2023, 20(2):290-293.
[14]	Tanabe H, Murayama R, Yabunaka K, et al. Low-angled peripheral intravenous catheter tip placement decreases phlebitis[J]. J Vasc Access, 2016, 17(6):542-547. doi: 10.5301/jva.5000601 pmid: 27646924
[15]	邓兆宏, 王汉琴, 王金勇, 等. 上肢浅静脉穿刺的应用解剖研究[J]. 中国现代医学杂志, 2010, 20(3):381-385.
	Deng ZH, Wang HQ, Wang JY, et al. Study on clinical application in uperficial veins of upper limb[J]. China J Mod Med, 2010, 20(3):381-385.
[16]	Corbo J, Fu LQ, Silver M, et al. Comparison of laboratory values obtained by phlebotomy versus saline lock devices[J]. Acad Emerg Med, 2007, 14(1):23-27. pmid: 17099189
[17]	刘晨, 韩子良, 张能维, 等. 腹腔镜胃袖状切除手术对肥胖患者凝血系统的影响[J]. 中国微创外科杂志, 2019, 19(10):910-914.
	Liu C, Han ZL, Zhang NW, et al. Effects of the of laparoscopic sleeve gastrectomy for coagulation system in obese patients[J]. Chin J Minim Invasive Surg, 2019, 19(10):910-914.
[18]	叶圆圆, 王薇, 赵海建, 等. 我国2017年常规生化检验血液标本可接受性的现状调查[J]. 临床检验杂志, 2018, 36(6):467-471.
	Ye YY, Wang W, Zhao HJ, et al. National survey of blood specimen acceptability for clinical chemistry tests in 2017[J]. Chin J Clin Lab Sci, 2018, 36(6):467-471.
[19]	Cornes M, Ibarz M, Ivanov H, et al. Blood sampling guidelines with focus on patient safety and identification-a review[J]. Diagnosis, 2019, 6(1):33-37.
[20]	Penoyer D, Bennett M, Geddie PI, et al. Evaluation of processes,outcomes,and use of midline peripheral catheters for the purpose of blood collection[J]. Br J Nurs, 2021, 30(2):S24-S32.
[21]	Fan XW, Xu L, Wei WS, et al. Relationship between indwelling site and peripheral venous catheter-related complications in adult hospitalized patients:a systematic review and meta-analysis[J]. J Clin Nurs, 2023, 32(7/8):1014-1024.
[22]	胡花, 万永慧, 喻莹, 等. 迷你中线导管的研究现状及展望[J]. 护理学报, 2022, 29(5):47-51.
	Hu H, Wan YH, Yu Y, et al. Research status and prospect of mini midline catheter[J]. J Nurs China, 2022, 29(5):47-51.
[23]	Zhao LF, Fan XP, Zhao L, et al. Midline catheter tip position and catheter-related complications in antimicrobial therapy:a multi-center randomized controlled trial[J]. Int J Nurs Stud, 2023,141:104476.