消炎散对神经重症患者PICC术后机械性静脉炎的防治效果谢亚君许时来郑冬梅邓海霞张建影曾劲松〔摘要〕目的探讨消炎散外敷对神经重症患者经外周静脉置入中心静脉导管（peripherallyinsertedcentralcatheter，PICC）后机械性静脉炎（mechanicalphlebitis，MP）的防治作用及其机制。方法将512例PICC术后的神经重症患者随机分为观察组和对照组，每组256例。对照组予以PICC常规护理，观察组在常规护理基础上于置管后24h后加用消炎散外敷，每天1次，连敷3d，观察两组患者7d内MP的发生情况。将以上两组发生MP的患者再随机平均分为消炎散组和硫酸镁组，分别予以消炎散外敷和硫酸镁湿敷3d，观察两组的临床疗效并采用彩色多普勒检测两组治疗前后置管静脉壁厚度，采用ELISA法检测两组患者治疗前后血清肿瘤坏死因子-α（tumornecrosisfactor-α，TNF-α）、白细胞介素-8（interleukin8，IL-8）水平。结果观察组发生MP24例（9.38%），对照组发生MP48例（18.75%），兩组比较差异有统计学意义（P<0.01）;72例MP患者分组治疗结果显示：与治疗前比较，两组静脉壁厚度均明显减轻（P<0.05，P<0.01），消炎散组静脉壁厚度减轻差值明显大于硫酸镁组（P<0.01）;消炎散组血清TNF-α、IL-8水平均明显下降（P0.05）;消炎散组临床疗效及总有效率、显效率均明显优于硫酸镁组（P<0.05，P〔关键词〕机械性静脉炎;PICC;消炎散;静脉壁水肿;TNF-α;IL-8〔〕R268〔文献标志码〕B〔〕doi：10.3969/j.issn.1674-070X.2020.07.023〔Abstract〕ObjectiveTostudythepreventiveandtherapeuticeffectofXiaoyanPowderonmechanicalphlebitis（MP）afterperipherallyinsertedcentralcatheter（PICC）inpatientswithsevereneurologicaldiseases，aswellasitsmechanism.MethodsAtotalof512patientswithsevereneurologicaldiseasesafterPICCwererandomlydividedintoanobservationgroupandacontrolgroup，with256casesineachgroup.ThecontrolgroupwasnursedaccordingtoPICCnursingroutine.TheobservationgroupwastreatedwithXiaoyanPowderforexternalapplication24hoursaftercatheterizationonthebasisofroutinenursing，onceadayfor3days.Theoccurrenceofmechanicalphlebitiswithin7daysinthe2groupswasobserved.Thepatientswithmechanicalphlebitisintheabove2groupswererandomlydividedintoaXiaoyanPowdergroupandamagnesiumsulfategroup，andtheyweregivenXiaoyanPowderexternalapplicationandmagnesiumsulfatewetcompressfor3daysrespectively.Theclinicalefficacyofthe2groupswascomparedandthewalledemaofcatheterveinwasevaluatedbycolorDoppler.Serumlevelsoftumornecrosisfactor-α（TNF-α）andinterleukin8（IL-8）weremeasuredbyELISAbeforeandaftertreatment.ResultsTherewere24casesofmechanicalphlebitisintheobservationgroup（9.38%）and48casesofmechanicalphlebitisinthecontrolgroup（18.76%）.Therewassignificantdifferencebetweenthe2groups（P0.05）.Theclinicalefficacy，totaleffectiverate，markedeffectiverateoftheXiaoyanpowdergroupwerebetterthanthatofthemagnesiumsulfategroup（P〔Keywords〕mechanicalphlebitis;peripherallyinsertedcentralcatheter;XiaoyanPowder;veinwalledema;tumornecrosisfactor-α;interleukin8经外周静脉置入中心静脉导管（peripherallyinsertedcentralcatheter，PICC）是指通过外周静脉（贵要静脉或头臂静脉）穿刺置入导管，使导管尖端位于锁骨下静脉或上腔静脉，主要适用于需要输注化疗药物或高渗性药物的患者。神经重症患者由于输液时间长且急性期常常需要静脉输注甘露醇等高渗性液体，PICC置管已广泛应用。PICC置管避免了反复穿刺及高滲性药物外渗对组织的损害，同时减轻了护士的工作量。然而，临床发现神经重症患者由于意识障碍、偏瘫等因素使PICC术后容易出现导管移位、机械性静脉炎（mechanicalphlebitis，MP）、静脉血栓等各种并发症，其中MP为最常见的并发症之一[1]。MP常发生于PICC术后3～7d，主要表现为穿刺部位及导管走行区域出现皮肤紧绷感、烧灼样痛及红...