目的 对比分析钝性分离扩皮法与常规扩皮法对乳腺癌术后患者经外周静脉置入中心静脉导管（PICC）置管应用效果。方法 选取2022年4月—2024年4月在天津肿瘤医院空港医院接受治疗的120例乳腺癌术后PICC置管患者,依据随机数字表法进行分组处理。对照组60例给予常规扩皮法,观察组60例给予钝性分离扩皮法,对比两组患者扩皮结果。结果 观察组患者满意度为96.67%,对照组患者满意度为86.67%（χ²=3.927,P=0.048）;观察组患者的穿刺点血液浸湿面积分别为穿刺后即刻（0.87±0.14）cm²、1 d后（4.89±0.94）cm²以及3 d后（0.21±0.05）cm²,均低于对照组的（2.74±0.63）（9.89±2.04）（0.44±0.12）cm²,对比差异有统计学意义（t=22.444、17.243、13.704,P<0.05）;观察组患者一次性送鞘成功率为98.33%,对照组患者一次性送鞘成功率为88.33%,观察组高于对照组（χ²=4.821,P=0.028）;扩皮前两组患者的VAS评分无差异（P>0.05）,扩皮后两组患者的VAS评分均降低,且观察组（1.75±0.54）分低于对照组（3.89±1.22）分,对比差异有统计学意义（t=12.425,P<0.001）;观察组患者不良事件发生率为5.00%,对照组患者不良事件发生率为16.67%,观察组患者不良事件发生率低于对照组（χ²=4.227,P<0.05）。结论 钝性分离扩皮法能够降低穿刺点血液浸湿面积及不良事件发生率,提高一次性送鞘成功率,减轻患者疼痛感,提高患者满意度。

Objective To analyze the effect of blunt separating skin expansion and conventional skin expansion in PICC catheterization of patients after breast cancer surgery. Methods From April 2022 to April 2024,120 patients with postoperative PICC catheterization for breast cancer were selected and grouped according to the random number table method．Sixty patients in the control group received conventional skin expansion,and 60 patients in the observation group received blunt separation skin expansion,which the results of the two groups were compared．Results The patient satisfaction was 96.67% in the observation group,86.67% in the control group（χ²=3.927,P=0.048,P<0.05）．In the observation group,the blood immersion area after catheterization,after 1 d and 3 d were（0.87±0.14）,（4.89±0.94）,（0.21±0.05）cm²,lower than those of the control group [（2.74±0.63）（9.89±2.04）（0.44±0.12）cm²],the comparative difference was statistically significant（t=22.444,17.243,13.704,P<0.05）．The success rate of disposable sheath delivery in the observation group was 98.33%,which was higher than 88.33% in the control group（χ²=4.821,P=0.028<0.05）．There was no difference in VAS scores between the two groups before the intervention（P>0.05）,VAS scores decreased in both groups after the intervention,the score of the observation group（1.75±0.54）was lower than that of the control group（3.89±1.22）,the difference was statistically significant（t=12.425,P<0.001）．The incidence of adverse events in the observation group was 5.00%,and in the control group was 16.67%,which difference was significant（χ²=4.227,P<0.05）．Conclusions Blunt separating skin expansion can reduce the area of blood immersion and the incidence of adverse events,improve the success rate of disposable sheath delivery,reduce patient pain,improve patient satisfaction,and have significant clinical application value．

目的 探讨超声引导下外周静脉置入中心静脉导管(PICC)老年患者常见并发症的预防与护理措施。方法 回顾性分析本院2019年12月—2021年1月间收治的116例PICC置管老年患者,根据是否实施超声引导下PICC置管并发症专项预防护理(后简称专项护理)将入选患者分配为实施组及对照组各58例,对比2组患者穿刺效果、并发症发生情况,评估2组患者护理前后的心理状态变化情况,调查患者满意度。结果 实施组一次穿刺成功、头端到位率、头端最佳率均高于对照组,平均穿刺次数、操作时间均少于对照组,差异均有统计学意义(P<0.05);实施组各种并发症总发生率为18.97%,对照组为46.55%,2组差异有统计学意义(P<0.05);置管后2组患者焦虑自评量表、抑郁自评量表评分均低于置管前,且实施组均低于对照组,差异均有统计学意义(P<0.05);实施组患者总满意率为96.55%,对照组为77.59%,实施组高于对照组,差异有统计学意义(P<0.05)。结论 专项预防护理措施能够提高老年患者超声引导下外周静脉置入中心导管的穿刺准确性,降低置管相关并发症发生风险,缓解患者心理压力,提高患者满意度。

Objective To explore the preventing and nursing measures of common complications in elderly patients with ultrasound-guided peripherally inserted central catheter (PICC). Methods The data of 116 elderly patients with PICC catheterization in our hospital from December 2019 to January 2021 were retrospectively analyzed.Patients were divided into implementation group and control group (58 cases each) according to whether they received special preventive nursing for complications of ultrasound-guided PICC catheterization (specialized nursing). The catheterization outcomes and complications of the two groups were compared, the changes in the psychological state were evaluated, and satisfaction rate of the patients was investigated. Results The success rate of the first catheterization, the head-end in place, and ideal placement of the head-end in implementation group were higher than those of the control group, the average number of catheterization and operation time were less than those of the control group, and the differences were statistically significant (P<0.05). The total incidence of various complications in the implementation group was 18.97%, while that in the control group was 46.55%, the difference between two groups was statistically significant (P<0.05). The scores of Self-Rating Anxiety Scale and Self-Rating Depression Scale of the two groups after PICC catheterization were lower than those before catheterization, and the implementation group was lower than the control group, the differences were statistically significant (P<0.05). The total satisfaction rate of patients in the implementation group was 96.55%, and that in the control group was 77.59%, which difference was statistically significant (P<0.05). Conclusion Special preventive nursing measures could improve the catheterization accuracy of ultrasound-guided PICC for elderly patients, reduce the risk of catheter-related complications, relieve the psychological pressure of patients, and improve patients’ satisfaction.

       目的  对比分析钝性分离扩皮法与常规扩皮法对乳腺癌术后患者经外周静脉置入中心静脉导管（PICC）置管应用效果。方法  选取2022年4月—2024年4月在天津肿瘤医院空港医院接受治疗的120例乳腺癌术后PICC置管患者，依据随机数字表法进行分组处理。对照组60例给予常规扩皮法，观察组60例给予钝性分离扩皮法，对比两组患者扩皮结果。结果  观察组患者满意度为96.67%，对照组患者满意度为86.67%（χ ² =3.927，P=0.048）；观察组患者的穿刺点血液浸湿面积分别为穿刺后即刻（0.87±0.14）cm² 、1 d后（4.89±0.94）cm² 以及3 d后（0.21±0.05）cm² ，均低于对照组的（2.74±0.63）（9.89±2.04）（0.44±0.12）cm² ，对比差异有统计学意义（t=22.444、17.243、13.704，P＜0.05）；观察组患者一次性送鞘成功率为98.33%，对照组患者一次性送鞘成功率为88.33%，观察组高于对照组（χ ² =4.821，P=0.028）；扩皮前两组患者的VAS评分无差异（P＞0.05），扩皮后两组患者的VAS评分均降低，且观察组（1.75±0.54）分低于对照组（3.89±1.22）分，对比差异有统计学意义（t=12.425，P＜0.001）；观察组患者不良事件发生率为5.00%，对照组患者不良事件发生率为16.67%，观察组患者不良事件发生率低于对照组（χ ² =4.227，P＜0.05）。结论  钝性分离扩皮法能够降低穿刺点血液浸湿面积及不良事件发生率，提高一次性送鞘成功率，减轻患者疼痛感，提高患者满意度。

       Objective  To analyze the effect of blunt separating skin expansion and conventional skin expansion in PICC catheterization of patients after breast cancer surgery．Methods  From April 2022 to April 2024，120 patients with postoperative PICC catheterization for breast cancer were selected and grouped according to the random number table method．Sixty patients in the control group received conventional skin expansion，and 60 patients in the observation group  received blunt separation skin expansion，which the results of the two groups were compared．Results  The patient satisfaction was 96.67% in the observation group，86.67% in the control group（χ ² =3.927，P=0.048，P＜0.05）．In the observation group，the blood immersion area after catheterization，after 1 d and 3 d were（0.87±0.14），（4.89±0.94），（0.21±0.05）cm² ，lower than those of the control group ［（2.74±0.63）（9.89±2.04）（0.44±0.12）cm² ］，the comparative difference was statistically significant（t=22.444，17.243，13.704，P＜0.05）．The success rate of disposable sheath delivery in the observation group was 98.33%，which was higher than 88.33% in the control group（χ ² =4.821，P=0.028＜0.05）．There was no difference in VAS scores between the two groups before the intervention（P＞0.05），VAS scores decreased in both groups after the intervention，the score of the observation group（1.75±0.54）was lower than that of the control group（3.89±1.22），the difference was statistically significant（t=12.425，P＜0.001）．The incidence of adverse events in the observation group was 5.00%，and in the control group was 16.67%，which difference was significant（χ ² =4.227，P＜0.05）．Conclusions  Blunt separating skin expansion can  reduce the area of blood immersion and the incidence of adverse events，improve the success rate of disposable sheath delivery，reduce patient pain，improve patient satisfaction，and have significant clinical application value．