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Article(id=1322167903458276083, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322167871413796899, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.03.018, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1743264000000, receivedDateStr=2025-03-30, revisedDate=1767715200000, revisedDateStr=2026-01-07, acceptedDate=null, acceptedDateStr=null, onlineDate=1793158992876, onlineDateStr=2026-10-28, pubDate=1770652800000, pubDateStr=2026-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793158992876, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793158992876, creator=13701087609, updateTime=1793158992876, updator=13701087609, issue=Issue{id=1322167871413796899, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='3', pageStart='353', pageEnd='528', issueExtLink='null', onlineDate='null', pubDate='1770652800000', pubDateStr='2026-02-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793158985236, creator='13701087609', updateTime=1793158985236, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=479, endPage=483, ext={EN=ArticleExt(id=1322167903667991284, articleId=1322167903458276083, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Application of modified Seldinger invasive technique in PICC catheterization for very low and extremely low birth weight infants, columnId=1220689488284668633, journalTitle=Chinese Nursing Research, columnName=Comprehensive Study, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the application effect of modified Seldinger invasive technique in peripherally inserted central venous catheters(PICC) of extremely low birth weight infants.

Methods

A total of 496 extremely low birth weight infants who underwent PICC catheterization in the neonatal intensive care unit of Children's Hospital of Fudan University from July 2019 to May 2022 were selected as the study subjects.From July 2019 to October 2020,children who urderwent traditional catheterization techniques with a puncture sheath needle served as the control group.From November 2020 to May 2022,children who urderwent the improved Seldinger minimally invasive catheterization technique with a 24G indwelling needle served as the test group.One-time puncture success rate,the incidence of bleeding at the puncture site,the incidence of catheter-related thrombosis,the incidence of limb swelling,and the occurrence of phlebitis after catheterization between the two groups of newborns were compared.

Results

The one-time puncture success rate of the test group(67.65%) was higher than that of the control group(16.10%).The incidence of bleeding at the puncture site(2.94%) was lower than that of the control group(43.49%).The incidence of phlebitis(6.37%) was lower than that of the control group(12.33%).There were statistically significant differences between the two groups(P<0.05).

Conclusions

The use of modified seldinger technique minimally invasive technique for PICC catheterization in extremely low birth weight infants could not only improve the success rate of a single puncture,but also reduce the incidence of bleeding and phlebitis at the puncture site.

, authors=Xi TANG, Xiaojing HU, Tianchan LYU, Lili YAO, Li WANG, Liling LI, authorsList=Xi TANG, Xiaojing HU, Tianchan LYU, Lili YAO, Li WANG, Liling LI, authorCompany=null, correspAuthors=Liling LI, authorNote=null, correspAuthorsNote=
LI Liling, E-mail:
, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322167904087421685, articleId=1322167903458276083, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=改良塞丁格微创技术在极低/超低出生体重儿PICC置管中的应用, columnId=1220689488938980091, journalTitle=护理研究, columnName=综合研究, runingTitle=null, highlight=null, articleAbstract=
目的

探讨改良塞丁格微创技术在极低/超低出生体重儿经外周静脉穿刺中心静脉置管（PICC）中的应用效果。

方法

选取2019年7月—2022年5月在复旦大学附属儿科医院新生儿重症监护室进行PICC置管的496例极低/超低出生体重儿为研究对象，其中2019年7月—2020年10月采用传统置管技术，使用穿刺鞘针进行穿刺置管的患儿作为对照组；2020年11月—2022年5月采用改良塞丁格微创置管技术，使用24G留置针进行穿刺置管的患儿作为试验组。比较两组患儿置管时的一次置管成功率、穿刺点渗血发生率、导管相关血栓发生率、肢体肿胀发生率及置管后静脉炎的发生情况。

结果

试验组一次置管成功率（67.65%）高于对照组（16.10%）；穿刺点渗血发生率（2.94%）低于对照组（43.49%）；静脉炎发生情况（6.37%）低于对照组（12.33%），差异均有统计学意义（P<0.05）。

结论

对极低/超低出生体重儿进行PICC置管时采用改良塞丁格微创技术，不仅能提高一次置管成功率，还能降低其穿刺点渗血及静脉炎的发生率。

, authors=唐熙, 胡晓静, 吕天婵, 姚莉莉, 王丽, 李丽玲*, *, authorsList=唐熙, 胡晓静, 吕天婵, 姚莉莉, 王丽, 李丽玲, authorCompany=null, correspAuthors=李丽玲, authorNote=

唐熙，主管护师，本科

, correspAuthorsNote=
李丽玲，E-mail：
LI Liling, E-mail:
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year=2015, volume=null, issue=10, pageStart=953, pageEnd=955, url=null, language=null, rfNumber=29, rfOrder=28, authorNames=赵京雷, 于新颖, 范玲, journalName=中国医科大学学报, refType=null, unstructuredReference=赵京雷,于新颖,范玲.10例新生儿经下肢静脉置入中心静脉导管的观察及护理[J].中国医科大学学报,2015(10):953-955., articleTitle=10例新生儿经下肢静脉置入中心静脉导管的观察及护理, refAbstract=null), Reference(id=1322529967435534401, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322167903458276083, doi=null, pmid=null, pmcid=null, year=2018, volume=32, issue=4, pageStart=611, pageEnd=613, url=null, language=null, rfNumber=30, rfOrder=29, authorNames=雷静, 黄剑平, 黄玉葵, journalName=护理研究, refType=null, unstructuredReference=雷静,黄剑平,黄玉葵,等.B超引导联合改良塞丁格技术在肱静脉置入PICC导管中的应用研究[J].护理研究,2018,32(4):611-613., articleTitle=B超引导联合改良塞丁格技术在肱静脉置入PICC导管中的应用研究, refAbstract=null), Reference(id=1322529967511031874, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322167903458276083, doi=null, pmid=null, pmcid=null, year=2009, volume=28, issue=11, pageStart=966, pageEnd=970, url=null, language=null, rfNumber=31, rfOrder=30, authorNames=TSAI M H, LIEN R, WANG J W, journalName=The Pediatric Infectious Disease Journal, refType=null, unstructuredReference=TSAI M H,LIEN R,WANG J W,et al.Complication rates with central venous catheters inserted at femoral and non-femoral sites in very low birth weight infants[J].The Pediatric Infectious Disease Journal,2009,28(11):966-970., articleTitle=Complication rates with central venous catheters inserted at femoral and non-femoral sites in very low birth weight infants, refAbstract=null), Reference(id=1322529967586529347, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322167903458276083, doi=null, pmid=null, pmcid=null, year=2019, volume=25, issue=4, pageStart=87, pageEnd=89, url=null, language=null, rfNumber=32, rfOrder=31, authorNames=黄菊华, 张甘棠, 周宾华, journalName=齐鲁护理杂志, refType=null, unstructuredReference=黄菊华,张甘棠,周宾华,等.不同PICC置管方式对肿瘤化疗患者常见并发症的影响[J].齐鲁护理杂志,2019,25(4):87-89., articleTitle=不同PICC置管方式对肿瘤化疗患者常见并发症的影响, refAbstract=null), Reference(id=1322529967653638212, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322167903458276083, doi=null, pmid=null, pmcid=null, year=2018, volume=35, issue=24, pageStart=56, pageEnd=58, url=null, language=null, rfNumber=33, rfOrder=32, authorNames=陈立姣, 朱薇, 钦晓英, journalName=解放军护理杂志, refType=null, unstructuredReference=陈立姣,朱薇,钦晓英,等.两种不同钝性分离法在超声引导下经外周静脉穿刺中心静脉导管置管的效果评价[J].解放军护理杂志,2018,35(24):56-58., articleTitle=两种不同钝性分离法在超声引导下经外周静脉穿刺中心静脉导管置管的效果评价, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322529960464602096, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322167903458276083, xref=1, ext=[AuthorCompanyExt(id=1322529960481379313, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322167903458276083, companyId=1322529960464602096, language=EN, 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Comparison of general information between two groups

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项目分类对照组（n=292）试验组（n=204）P
胎龄（周）29.19±2.2829.31±2.210.452
体重（g）1 150.77±243.181 155.53±235.840.716
性别[例(%)]男160（54.79）101（49.51）0.246
女132（45.21）103（50.49）
PICC留置时间（d）19.19±10.9719.86±11.280.640
穿刺部位[例(%)]踝大隐静脉15（5.14）83（40.69）<0.001
腘窝大隐静脉106（36.30）55（26.96）
小隐静脉47（16.10）49（24.02）
腘静脉63（21.58）10（4.90）
腹股沟静脉61（20.89）7（3.43）
), ArticleFig(id=1322529962897297437, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322167903458276083, language=CN, label=表1, caption=

两组一般资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类对照组（n=292）试验组（n=204）P
胎龄（周）29.19±2.2829.31±2.210.452
体重（g）1 150.77±243.181 155.53±235.840.716
性别[例(%)]男160（54.79）101（49.51）0.246
女132（45.21）103（50.49）
PICC留置时间（d）19.19±10.9719.86±11.280.640
穿刺部位[例(%)]踝大隐静脉15（5.14）83（40.69）<0.001
腘窝大隐静脉106（36.30）55（26.96）
小隐静脉47（16.10）49（24.02）
腘静脉63（21.58）10（4.90）
腹股沟静脉61（20.89）7（3.43）
), ArticleFig(id=1322529962968600606, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322167903458276083, language=EN, label=Table 2, caption=

Comparison of one-time puncture success rates between two groups

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数一次穿刺成功（例）成功率（%）
对照组2924716.10
试验组20413867.65
), ArticleFig(id=1322529963052486687, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322167903458276083, language=CN, label=表2, caption=

两组一次置管成功率比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数一次穿刺成功（例）成功率（%）
对照组2924716.10
试验组20413867.65
), ArticleFig(id=1322529963148955680, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322167903458276083, language=EN, label=Table 3, caption=

Comparison of incidence of phlebitis between two groups

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数发生（例）发生率（%）
对照组2923612.33
试验组204136.37
), ArticleFig(id=1322529963216064545, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322167903458276083, language=CN, label=表3, caption=

两组静脉炎发生情况比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数发生（例）发生率（%）
对照组2923612.33
试验组204136.37
), ArticleFig(id=1322529963278979106, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322167903458276083, language=EN, label=Table 4, caption=

Comparison of puncture point bleeding, limb swelling, and catheter-related thrombus occurrence between two groups

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数穿刺点渗血导管相关血栓肢体肿胀
有无有无有无
P<0.0010.7170.460
对照组292127（43.49）165（56.51）2（0.68）290（99.32）27（9.24）265（90.75）
试验组2046（2.94）198（97.06）2（0.98）202（99.02）23（11.27）181（88.73）
), ArticleFig(id=1322529963350282275, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322167903458276083, language=CN, label=表4, caption=

两组穿刺点渗血、肢体肿胀及导管相关血栓发生情况比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数穿刺点渗血导管相关血栓肢体肿胀
有无有无有无
P<0.0010.7170.460
对照组292127（43.49）165（56.51）2（0.68）290（99.32）27（9.24）265（90.75）
试验组2046（2.94）198（97.06）2（0.98）202（99.02）23（11.27）181（88.73）
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改良塞丁格微创技术在极低/超低出生体重儿PICC置管中的应用
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唐熙 , 胡晓静 , 吕天婵 , 姚莉莉 , 王丽 , 李丽玲 *, *
护理研究 | 综合研究 2026,40(3): 479-483
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护理研究 |综合研究 2026 , 40 (3) : 479 -483
改良塞丁格微创技术在极低/超低出生体重儿PICC置管中的应用
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唐熙, 胡晓静, 吕天婵, 姚莉莉, 王丽, 李丽玲*, *
作者信息
  • 1复旦大学附属儿科医院，上海 201102
通讯作者:
李丽玲，E-mail：
LI Liling, E-mail:
作者简介:

唐熙，主管护师，本科

Application of modified Seldinger invasive technique in PICC catheterization for very low and extremely low birth weight infants
Xi TANG, Xiaojing HU, Tianchan LYU, Lili YAO, Li WANG, Liling LI
Affiliations
  • 1Children's Hospital of Fudan University, Shanghai 201102 China
    • Corresponding Author:
    LI Liling, E-mail:
出版时间: 2026-02-10 doi: 10.12102/j.issn.1009-6493.2026.03.018
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摘要
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目的

探讨改良塞丁格微创技术在极低/超低出生体重儿经外周静脉穿刺中心静脉置管（PICC）中的应用效果。

方法

选取2019年7月—2022年5月在复旦大学附属儿科医院新生儿重症监护室进行PICC置管的496例极低/超低出生体重儿为研究对象，其中2019年7月—2020年10月采用传统置管技术，使用穿刺鞘针进行穿刺置管的患儿作为对照组；2020年11月—2022年5月采用改良塞丁格微创置管技术，使用24G留置针进行穿刺置管的患儿作为试验组。比较两组患儿置管时的一次置管成功率、穿刺点渗血发生率、导管相关血栓发生率、肢体肿胀发生率及置管后静脉炎的发生情况。

结果

试验组一次置管成功率（67.65%）高于对照组（16.10%）；穿刺点渗血发生率（2.94%）低于对照组（43.49%）；静脉炎发生情况（6.37%）低于对照组（12.33%），差异均有统计学意义（P<0.05）。

结论

对极低/超低出生体重儿进行PICC置管时采用改良塞丁格微创技术，不仅能提高一次置管成功率，还能降低其穿刺点渗血及静脉炎的发生率。

改良塞丁格技术  /  微创技术  /  PICC置管  /  极低出生体重儿  /  超低出生体重儿  /  早产儿
Objective

To explore the application effect of modified Seldinger invasive technique in peripherally inserted central venous catheters(PICC) of extremely low birth weight infants.

Methods

A total of 496 extremely low birth weight infants who underwent PICC catheterization in the neonatal intensive care unit of Children's Hospital of Fudan University from July 2019 to May 2022 were selected as the study subjects.From July 2019 to October 2020,children who urderwent traditional catheterization techniques with a puncture sheath needle served as the control group.From November 2020 to May 2022,children who urderwent the improved Seldinger minimally invasive catheterization technique with a 24G indwelling needle served as the test group.One-time puncture success rate,the incidence of bleeding at the puncture site,the incidence of catheter-related thrombosis,the incidence of limb swelling,and the occurrence of phlebitis after catheterization between the two groups of newborns were compared.

Results

The one-time puncture success rate of the test group(67.65%) was higher than that of the control group(16.10%).The incidence of bleeding at the puncture site(2.94%) was lower than that of the control group(43.49%).The incidence of phlebitis(6.37%) was lower than that of the control group(12.33%).There were statistically significant differences between the two groups(P<0.05).

Conclusions

The use of modified seldinger technique minimally invasive technique for PICC catheterization in extremely low birth weight infants could not only improve the success rate of a single puncture,but also reduce the incidence of bleeding and phlebitis at the puncture site.

modified Seldinger technique  /  minimally invasive technique  /  peripherally inserted central venous catheters  /  very low birth weight infant  /  extremely low birth weight infant  /  premature
唐熙, 胡晓静, 吕天婵, 姚莉莉, 王丽, 李丽玲. 改良塞丁格微创技术在极低/超低出生体重儿PICC置管中的应用. 护理研究, 2026 , 40 (3) : 479 -483 . DOI: 10.12102/j.issn.1009-6493.2026.03.018
Xi TANG, Xiaojing HU, Tianchan LYU, Lili YAO, Li WANG, Liling LI. Application of modified Seldinger invasive technique in PICC catheterization for very low and extremely low birth weight infants[J]. Chinese Nursing Research, 2026 , 40 (3) : 479 -483 . DOI: 10.12102/j.issn.1009-6493.2026.03.018
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经外周置入中心静脉导管（peripherally inserted central catheter，PICC）于20世纪80年代引入新生儿重症监护室（neonatal intensive care unit，NICU），用于高危新生儿肠外营养管理及连续性药物输注，现已成为新生儿重症监护室重要的血管通路装置(vascular access device，VAD)[1-3]。PICC置管的首要步骤为静脉穿刺，传统的置管方法采用穿刺鞘针进行穿刺，穿刺点损伤较大、渗血多，给患儿带来更多的疼痛[4]。改良塞丁格微创置管技术采用与血管直径匹配的外周静脉留置针对外周浅表静脉进行静脉穿刺，可减轻病人疼痛、减少静脉创伤、避免血肿形成，最大限度地减少对周围血管和神经的损伤[5]。近年来，临床上采用改良塞丁格微创置管为病人进行PICC置管，一次置管成功率显著提高，穿刺点渗血及静脉炎的发生率显著降低[6]。极低/超低出生体重早产儿是指出生体重小于1 500 g的新生儿，该类人群外周静脉非常细且脆，穿刺鞘置入较为困难。因此，采用传统的置管方法进行PICC置管的难度相对较大[7]。改良塞丁格微创置管技术在极低/超低出生体重儿中的临床应用可能会带来更好的效果，但相关报道较少。本研究对复旦大学附属儿科医院新生儿重症监护室2019年7月—2022年5月住院需要进行PICC置管的496例患儿采用传统的穿刺鞘针以及改良塞丁格微创置管2种方法进行穿刺置管，并比较2种方法的效果，现将研究结果报道如下。
1　对象与方法
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1.1　研究对象
选取2019年7月—2022年5月在复旦大学附属儿科医院新生儿重症监护室进行PICC置管的496例极低/超低出生体重儿为研究对象。纳入标准：1）出生体重<1 500 g；2）符合PICC置管指征，无置管禁忌证；3）住院期间进行PICC置管。排除院外带入PICC的新生儿。样本量：已有研究显示，改良塞丁格微创技术一次置管成功率为72%，传统技术的一次穿刺成功发生率为40%[6]。α为5%，β为10%，考虑5%的丢失率，样本量至少为每组57例。将2019年7月—2020年10月采用传统置管技术，使用穿刺鞘针进行穿刺置管的292例患儿作为对照组；2020年11月—2022年5月采用改良塞丁格微创置管技术，使用24G留置针进行穿刺置管的204例患儿作为试验组。本研究已通过复旦大学附属儿科医院伦理委员会审查（编号：复儿伦审〔2019〕297号），所有患儿家属知情同意。
1.2　研究方法
1.2.1　对照组
采用传统置管技术，使用穿刺鞘针进行穿刺置管。PICC穿刺前：患儿准备、物品准备、环境准备。穿刺时：1）穿刺者使用PICC穿刺鞘针穿刺静脉，穿刺成功后，退出针芯；2）修剪后的PICC从鞘针套管中缓慢置入血管，送至预定长度；3）撇开鞘针套管，调整外管长度；4）置管后固定导管、记录置管过程、处理物品。
1.2.2　试验组
采用改良塞丁格微创置管技术，使用24G留置针进行穿刺置管。PICC穿刺前：患儿准备、物品准备、环境准备。穿刺时：1）穿刺者使用24G留置针行外周静脉穿刺；2）2 mL注射器接留置针套管，推注生理盐水1 mL评估导管是否通畅；3）修剪导丝，导丝长度大于修剪后PICC总长的10~15 cm。测量并标记送入留置针套管的导丝长度，长于留置针总长1 cm；4）导丝头端缓慢插入留置针套管至标记处，手持导丝外露部分固定不动，取下套管；5）另一操作者使用生理盐水纱布擦净导丝上血液与凝血；6）修剪PICC导管，将导丝尾端穿入PICC尖端，PICC送至穿刺点处，旋转导管进皮再送入血管2 cm，抽出导丝；7）PICC导管连接注射器，推注生理盐水，确保导管通畅，导管送至测量长度；8）置管后固定导管、记录置管过程、处理物品。
1.3　观察指标
1.3.1　一次置管成功率
一针穿刺成功，导管成功送入预定长度为成功，2针及以上穿刺均为一次穿刺失败[8]。
1.3.2　静脉炎发生情况
统计两组置管1周内静脉炎发生时间、发生率及转好时间。穿刺部位出现发红，肿胀，条索状硬肿等为发生静脉炎[9]。
1.3.3　穿刺点渗血、肢体肿胀及导管相关血栓的发生率
1）穿刺点渗血：置管24 h内穿刺点发生渗血[10]；2）肢体肿胀：置管期间穿刺肢体测量的腿围或臂围与对侧肢体相比大于0.5 cm[11-12]。3）导管相关血栓：置管期间超声检查显示血栓位于导管所在的静脉或邻近血管，发病时间与导管使用时间相符。
1.4　统计学方法
采用SPSS 22.0软件进行统计分析，符合正态分布的定量资料以均数±标准差(x±s）表示，行t检验；定性资料采用例数、百分比（%）表示，进行χ2检验，以P<0.05为差异有统计学意义。
2　结果
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2.1　两组一般资料比较
两组胎龄、体重、性别、PICC留置时间、穿刺部位等一般资料比较，差异均无统计学意义（P>0.05)，具有可比性。详见表1。
2.2　两组一次置管成功率比较
结果显示，对照组一次穿刺成功47例，成功率为16.10%；试验组一次穿刺成功138例，成功率为67.65%，两组比较差异有统计学意义（P<0.001）。详见表2。
2.3　两组静脉炎发生情况比较
结果显示，对照组中，36例（12.33%）发生静脉炎，静脉炎发生时间为置管后(3.30±1.87） d，持续（7.33±3.86） d好转；试验组中，13例（6.37%）发生静脉炎，静脉炎发生时间为置管后(3.07±1.18) d，持续(5.76±2.68) d好转；试验组静脉炎发生率低于对照组，差异有统计学意义（P<0.05）；两组静脉炎发生时间及持续时间比较，差异均无统计学意义（P>0.05）。详见表3。
2.4　两组穿刺点渗血、肢体肿胀及血栓发生情况比较
结果显示，对照组127例（43.49%）发生渗血，2例（0.68%）发生血栓，27例（9.24%）发生肿胀；试验组6例（2.94%）发生渗血，2例（0.98%）发生血栓，23例（11.27%）发生肿胀。试验组渗血发生率低于对照组，差异有统计学意义（P<0.05）；两组血栓发生率及肿胀发生率比较，差异均无统计学意义（P>0.05）。详见表4。
3　讨论
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3.1　改良塞丁格微创技术可提高重症监护室极低/超低出生体重儿PICC置管一次置管成功率
本研究结果显示，试验组一次置管成功率（67.65%）高于对照组（16.10%），差异有统计学意义（P<0.05）。表明改良塞丁格微创技术可提高重症监护室极低/超低出生体重儿PICC置管一次置管成功率，与Song[13]等研究结果一致。静脉穿刺成功是新生儿PICC置管的首要环节，传统PICC穿刺针型号为20G，相对于早产儿及极低/超低出生体重儿的血管条件，穿刺针较粗，加之新生儿无法配合操作，在穿刺过程中容易损伤血管造成穿刺失败，反复穿刺易引起穿刺部位血肿[14]。改良塞丁格微创置管技术克服了穿刺鞘直径与血管管径不匹配问题，采用临床常用的24G留置针行外周静脉置管，其直径细，可增加穿刺人员对血管的选择范围，提高一次置管成功率[15]；24G留置针穿刺更为精准，可减轻血管损伤，避免穿刺处血肿，降低血管周围组织与神经损害，减轻穿刺部位疼痛，更适合高危新生儿PICC置管[16]。
3.2　改良塞丁格微创技术可降低重症监护室极低/超低出生体重儿PICC置管穿刺点渗血率
本研究结果显示，试验组穿刺点渗血发生率（2.94%）低于对照组（43.49%），差异有统计学意义（P<0.05）。表明改良塞丁格微创技术可降低重症监护室极低/超低出生体重儿PICC置管穿刺点渗血率，与肖嫔等[17]研究结果一致。穿刺点渗血的发生与置管工具相关，传统PICC穿刺鞘针直径粗，对血管及表皮的损伤大，出血量较多；24G留置针直径更细，针尖切面更小，血管创伤面更小，利于创面愈合。穿刺点渗血的发生与置管部位相关，对照组较多以腘窝大隐静脉（36.30%）、腘静脉（21.58%）及腹股沟静脉（20.89%）为穿刺部位，其管腔粗大，血管走行直，血管内压力更大，相较于试验组选择的踝大隐静脉（40.69%）等外周浅表静脉更容易渗血，需要延长压迫止血时间[18]。
3.3　改良塞丁格微创技术可降低重症监护室极低/超低出生体重儿PICC置管静脉炎发生率
本研究结果显示，试验组的静脉炎发生率为6.37%,低于对照组（12.33%），差异有统计学意义(P<0.05),表明改良塞丁格微创技术可降低重症监护室极低/超低出生体重儿PICC置管静脉炎发生率，与孙杉杉等[19]研究结果一致。新生儿PICC导管对于血管较细的极低/超低出生体重儿仍相对较粗，穿刺失败可能导致血肿、血管痉挛，增加穿刺次数。研究显示，穿刺次数增加是静脉炎的独立危险因素，提高一次置管成功率能有效降低静脉炎的发生[20]。本研究中试验组静脉炎的发生率低于对照组，可能与试验组的一次置管成功率高，避免反复穿刺及送管对血管内膜的机械性刺激有关系[21-22]。研究表明，降低静脉炎发生的措施包括：1）穿刺过程中避免送管过快，以0.5~1.0 cm/s推进；2）导管使用生理盐水湿润，当出现送管困难时不可强行推送，避免血管内膜损伤[23]；3）置管后沿穿刺点上方静脉走向贴水胶体敷料，预防静脉炎的发生[24]。静脉炎处理方法包括：在静脉炎处使用水胶体敷料，肢体肿胀时抬高肢体并使用喜辽妥局部按摩，促进静脉炎吸收[25]。本研究发现，两组静脉炎多在置管后3~4 d出现，临床护理者可在置管后3~4 d注意观察患儿有无发生静脉炎，早预防、早发现、早处理，减轻患儿疼痛[26]。
3.4　改良塞丁格微创技术增加了穿刺血管的选择
本研究结果显示，试验组主要穿刺部位为踝大隐静脉、腘窝大隐静脉及小隐静脉；对照组主要穿刺部位为腘窝大隐静脉、腘静脉及腹股沟静脉。研究表明，新生儿经下肢静脉PICC置管的并发症总发生率低于经上肢静脉置管。指南推荐新生儿置管首选大隐静脉，大隐静脉表浅恒定，容易定位及穿刺，分支少，走向直，管径粗，其具有PICC一次置管成功率高、导管堵塞和感染的发生率低等特点[27-29]。极低/超低出生体重儿的血管细，传统穿刺鞘针无法对大隐静脉进行成功穿刺，需要选择较粗的深静脉。深静脉肉眼不可见，只能通过解剖位置定位或触摸动脉的方法判断静脉的位置，可能出现定位不准而导致穿刺失败，反复穿刺损伤静脉壁，引起血小板聚集，增加血栓形成的可能，同时也有误伤股动脉及周围淋巴管的风险[30-31]。因此，改良塞丁格技术穿刺的血管范围更广，更容易实现浅表外周静脉穿刺置管。研究表明，借助超声能更直观地判断血管的位置、走向、内径，有更多的静脉选择，可选择最佳的血管，提高成功率，缩短置管时间[32-33]。本研究尚未开展超声引导技术，在后续的工作中可联合B超技术，对早产儿实施更精准的PICC置管护理。
4　小结
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综上所述，使用静脉留置针联合改良塞丁格技术对极低/超低出生体重儿进行PICC置管，不仅能显著提高一次置管成功率，同时能降低其穿刺点渗血及静脉炎的发生率，更适合早产儿。但是本研究为单中心的回顾性研究，未来还需要大样本的随机对照试验验证改良塞丁格微创技术在新生儿PICC中的优势。

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doi: 10.12102/j.issn.1009-6493.2026.03.018
  • 接收时间：2025-03-30
  • 首发时间：2026-10-28
  • 出版时间：2026-02-10
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  • 收稿日期：2025-03-30
  • 修回日期：2026-01-07
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    1复旦大学附属儿科医院，上海 201102

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李丽玲，E-mail：
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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