静脉营养液中加入肝素钠预防早产儿PICC导管堵塞的1例报告_《中国循证医学杂志》

作者：

 万兴丽 ¹ , 曾力楠 ²

1. 四川大学华西第二医院儿科（成都 610041）；2. 四川大学华西第二医院药学部（成都 610041）;

关键词：

早产儿经外周静脉穿刺中心静脉导管导管堵塞肝素钠循证治疗全合一静脉营养液

DOI：

10.7507/1672-2531.20120198

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　借助循证医学方法为1例经外周静脉穿刺中心静脉导管（PICC）输注全合一静脉营养液（TNA）的早产儿确定使用肝素钠预防PICC导管堵塞的治疗方案。
方法　在充分评估患儿的情况后，根据PICO原则提出临床问题，计算机检索Cochrane 图书馆、Cochrane Central Register of Controlled Trials （CCTR）、Database of Abstracts of Reviews of Effects （DARE）、National Guideline Clearing-house （NGC）、MEDLINE（Ovid）和CBM，检索时限从建库至2011年，纳入有关新生儿PICC导管堵塞的随机对照试验和系统评价，对所获证据进行评价并结合早产儿的生理情况后确定临床干预方案。
结果　共检索出与问题相关的RCT 4篇，系统评价1篇。通过对检索结果进行分析并结合患者家属意愿，为患儿制定以下治疗方案：每1 mL营养液中加入0.5 U肝素钠作为降低PICC导管堵管率的方法。应用期间注意监测患儿血常规及凝血功能，并记录导管开放时间及拔管原因。经上述治疗后，患儿顺利完成治疗计划并拔管，PICC留置和开放时间均为20天，其间未发生PICC堵管、导管血栓形成及导管相关的血行感染。使用肝素钠后也未发生肝素钠导致的血小板减少症的相关症状与体征及凝血功能障碍加重。
结论　采用循证治疗方法，为早产儿使用肝素钠确定合理的治疗方案，可预防PICC导管堵塞，减少导管血栓形成、导管相关的血行感染风险，保证治疗的顺利完成，保障患儿安全。

引用本文： 万兴丽,曾力楠. 静脉营养液中加入肝素钠预防早产儿PICC导管堵塞的1例报告. 中国循证医学杂志, 2012, 12(10): 1275-1278. doi: 10.7507/1672-2531.20120198 复制

1.	唐军, 熊英. 肝素预防新生儿经外周中心静脉置管相关感染的回顾性研究. 中国循证医学杂志, 2010, 10(9): 1023-1026.
2.	王晓燕, 佘燕朝, 公庆华, 等. 中心静脉导管堵塞原因及对策. 护理研究, 2007, 21(6): 1519-1521.
3.	唐军, 李熙鸿, 王华, 等. 静脉营养液中加入小剂量肝素预防新生儿中心静脉置管相关感染. 中国当代儿科杂志, 2009, 11(12): 983-985.
4.	Harms K, Herting E, Kruger T, et al. Percutaneous silastic catheters in newborn and prematureinfants. A report of experience with 497 catheters in 5 years. Monatsschrift fur Kinderheilkd, 1992, 140(638): 464-471.
5.	Klein JF, Shahrivar F. Use of percutaneous silastic central venous catheters in neonates and the management of infectious complications. American Journal of Perinatology, 1992, 9(32): 261-264.
6.	Randolph AG, Cook DJ, Gonzales CA, et al. Bene?t of heparin in peripheral venous and arterial catheters: systematic review and meta-analysis of randomized controlled trials. BMJ, 1998, 316(322): 969-975.
7.	Schmidt B, Andrew M. Neonatal thrombotic disease: prevention, diagnosis, and treatment. Journal of Pediatrics, 1988, 113(21): 407-410.
8.	Brismar B, Hardstedt C, Jacobson S, et al. Reduction ofcatheter-associated thrombosis in parenteral nutrition by intravenous heparin therapy. Archives of Surgery, 1982, 117(76): 1196-1199.
9.	Kamala F, Boo NY, Cheah FC, et al. Randomized controlled trial of heparin for prevention of blockage of peripherally inserted central catheters in neonates. Acta Paediatrica, 2002, 91(12): 1350-1356.
10.	Shah PS, Kalyn A, Satodia P, et al. A randomized, controlled trial of heparin versus placebo infusion to prolong the usability of peripherally placed percutaneous central venous catheters (PCVCs) in neonates: the HIP (Heparin Infusion for PCVC) study. Pediatrics, 2007, 119(1): 284-291.
11.	Birch P, Ogden S, Hewson M. A randomised controlled trial of heparin in total parenteral nutrition to prevent sepsis associated with neonatal long lines: the Heparin in Long Line Total Parenteral Nutrition (HILLTOP) trial. Archives of Diseases of Childhood Fetal and Neonatal Edition, 2010, 95(16): 252-257.
12.	Uslu S, Ozdemir H, Comert S, et al. The effect of low-dose heparin on maintaining peripherally inserted percutaneous central venous catheters in neonates. Journal of Perinatology: official journal of the California Perinatal Association, 2010, 30(12): 794-799.
13.	Shah PS, Shah VS. Continuous heparin infusion to preventthrombosis and catheter occlusion in neonates with peripherally placed percutaneous central venous catheters. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD002772. DOI: 10.1002/14651858. CD002772. pub3.
14.	蒋倩, 蒋刚, 周澄亚. 1例复发性卵巢癌患者的循证治疗. 中国循证医学杂志, 2011, 11(11): 1339-1341.

1. 唐军, 熊英. 肝素预防新生儿经外周中心静脉置管相关感染的回顾性研究. 中国循证医学杂志, 2010, 10(9): 1023-1026.
2. 王晓燕, 佘燕朝, 公庆华, 等. 中心静脉导管堵塞原因及对策. 护理研究, 2007, 21(6): 1519-1521.
3. 唐军, 李熙鸿, 王华, 等. 静脉营养液中加入小剂量肝素预防新生儿中心静脉置管相关感染. 中国当代儿科杂志, 2009, 11(12): 983-985.
4. Harms K, Herting E, Kruger T, et al. Percutaneous silastic catheters in newborn and prematureinfants. A report of experience with 497 catheters in 5 years. Monatsschrift fur Kinderheilkd, 1992, 140(638): 464-471.
5. Klein JF, Shahrivar F. Use of percutaneous silastic central venous catheters in neonates and the management of infectious complications. American Journal of Perinatology, 1992, 9(32): 261-264.
6. Randolph AG, Cook DJ, Gonzales CA, et al. Bene?t of heparin in peripheral venous and arterial catheters: systematic review and meta-analysis of randomized controlled trials. BMJ, 1998, 316(322): 969-975.
7. Schmidt B, Andrew M. Neonatal thrombotic disease: prevention, diagnosis, and treatment. Journal of Pediatrics, 1988, 113(21): 407-410.
8. Brismar B, Hardstedt C, Jacobson S, et al. Reduction ofcatheter-associated thrombosis in parenteral nutrition by intravenous heparin therapy. Archives of Surgery, 1982, 117(76): 1196-1199.
9. Kamala F, Boo NY, Cheah FC, et al. Randomized controlled trial of heparin for prevention of blockage of peripherally inserted central catheters in neonates. Acta Paediatrica, 2002, 91(12): 1350-1356.
10. Shah PS, Kalyn A, Satodia P, et al. A randomized, controlled trial of heparin versus placebo infusion to prolong the usability of peripherally placed percutaneous central venous catheters (PCVCs) in neonates: the HIP (Heparin Infusion for PCVC) study. Pediatrics, 2007, 119(1): 284-291.
11. Birch P, Ogden S, Hewson M. A randomised controlled trial of heparin in total parenteral nutrition to prevent sepsis associated with neonatal long lines: the Heparin in Long Line Total Parenteral Nutrition (HILLTOP) trial. Archives of Diseases of Childhood Fetal and Neonatal Edition, 2010, 95(16): 252-257.
12. Uslu S, Ozdemir H, Comert S, et al. The effect of low-dose heparin on maintaining peripherally inserted percutaneous central venous catheters in neonates. Journal of Perinatology: official journal of the California Perinatal Association, 2010, 30(12): 794-799.
13. Shah PS, Shah VS. Continuous heparin infusion to preventthrombosis and catheter occlusion in neonates with peripherally placed percutaneous central venous catheters. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD002772. DOI: 10.1002/14651858. CD002772. pub3.
14. 蒋倩, 蒋刚, 周澄亚. 1例复发性卵巢癌患者的循证治疗. 中国循证医学杂志, 2011, 11(11): 1339-1341.

《中国循证医学杂志》

静脉营养液中加入肝素钠预防早产儿PICC导管堵塞的1例报告

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《中国循证医学杂志》

静脉营养液中加入肝素钠预防早产儿PICC导管堵塞的1例报告

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