靜脈營養液中加入肝素鈉預防早產兒PICC導管堵塞的1例報告_《中國循證醫學雜志》

作者：

 萬興麗 ¹ , 曾力楠 ²

1. 四川大學華西第二醫院兒科（成都 610041）；2. 四川大學華西第二醫院藥學部（成都 610041）;

關鍵詞：

早產兒經外周靜脈穿刺中心靜脈導管導管堵塞肝素鈉循證治療全合一靜脈營養液

DOI：

10.7507/1672-2531.20120198

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目的　借助循證醫學方法為1例經外周靜脈穿刺中心靜脈導管（PICC）輸注全合一靜脈營養液（TNA）的早產兒確定使用肝素鈉預防PICC導管堵塞的治療方案。
方法　在充分評估患兒的情況后，根據PICO原則提出臨床問題，計算機檢索Cochrane 圖書館、Cochrane Central Register of Controlled Trials （CCTR）、Database of Abstracts of Reviews of Effects （DARE）、National Guideline Clearing-house （NGC）、MEDLINE（Ovid）和CBM，檢索時限從建庫至2011年，納入有關新生兒PICC導管堵塞的隨機對照試驗和系統評價，對所獲證據進行評價并結合早產兒的生理情況后確定臨床干預方案。
結果　共檢索出與問題相關的RCT 4篇，系統評價1篇。通過對檢索結果進行分析并結合患者家屬意愿，為患兒制定以下治療方案：每1 mL營養液中加入0.5 U肝素鈉作為降低PICC導管堵管率的方法。應用期間注意監測患兒血常規及凝血功能，并記錄導管開放時間及拔管原因。經上述治療后，患兒順利完成治療計劃并拔管，PICC留置和開放時間均為20天，其間未發生PICC堵管、導管血栓形成及導管相關的血行感染。使用肝素鈉后也未發生肝素鈉導致的血小板減少癥的相關癥狀與體征及凝血功能障礙加重。
結論　采用循證治療方法，為早產兒使用肝素鈉確定合理的治療方案，可預防PICC導管堵塞，減少導管血栓形成、導管相關的血行感染風險，保證治療的順利完成，保障患兒安全。

引用本文： 萬興麗,曾力楠. 靜脈營養液中加入肝素鈉預防早產兒PICC導管堵塞的1例報告. 中國循證醫學雜志, 2012, 12(10): 1275-1278. doi: 10.7507/1672-2531.20120198 復制

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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.
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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.	蔣倩, 蔣剛, 周澄亞. 1例復發性卵巢癌患者的循證治療. 中國循證醫學雜志, 2011, 11(11): 1339-1341.

1. 唐軍, 熊英. 肝素預防新生兒經外周中心靜脈置管相關感染的回顧性研究. 中國循證醫學雜志, 2010, 10(9): 1023-1026.
2. 王曉燕, 佘燕朝, 公慶華, 等. 中心靜脈導管堵塞原因及對策. 護理研究, 2007, 21(6): 1519-1521.
3. 唐軍, 李熙鴻, 王華, 等. 靜脈營養液中加入小劑量肝素預防新生兒中心靜脈置管相關感染. 中國當代兒科雜志, 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. 蔣倩, 蔣剛, 周澄亞. 1例復發性卵巢癌患者的循證治療. 中國循證醫學雜志, 2011, 11(11): 1339-1341.

《中國循證醫學雜志》

靜脈營養液中加入肝素鈉預防早產兒PICC導管堵塞的1例報告

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《中國循證醫學雜志》

靜脈營養液中加入肝素鈉預防早產兒PICC導管堵塞的1例報告

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