新生儿UVC置管术后肝脏血肿原因分析及防治策略

病例
1肝脓肿 2肝血肿 3肝血肿 4肝血肿
性别
女 男 男 男
表]UVC置管术后4例患儿基本资料及置管情况
胎龄(周)
30+4 34+4 34+1 29+4
出生体重(g) 1830 1850 2300 1500
置管深度(cm)
8.5 8.5
9 8
管端位置
T10 T11 T11 T10
1.2临床护理与治疗方法 4例均经床旁标准X线摄影确定UVC尖端位
[Key words] The newborn； Umbilical venous catheter； Hepatic hematoma/abscess； X-ray photography； Ultrasonic
脐静脉导管(umbilical venous catheter, UVC)置
管术是在新生儿脐静脉尚未关闭时 ，将硅胶导管经 脐静脉快速置入下腔静脉的深静脉置管术，可同时 输注多种药物,以及避免新生儿,尤其极低/超低出 生体重儿反复外周穿刺,利于患儿康复3]0但在临 床应用中可见UVC置管术后肝血肿病例。本文回
1006
医学影像学杂志2021年第31卷第6期 J Med Imaging Vol. 31 No. 6 2021
and infusion factors, such as high penneability drugs. This suggests that UVC ultrasound catheter postoperative line pipe position determines the UVC, gives line cluster nursing countermeasures, and closely observes children condition change for timely detec­ tion and early treatment.
250021
【摘 要】目的 观察新生儿脐静脉导管(umbilical venous catheter, UVC)置管术后临床表现及影像学特点，探讨UVC
置管术后并发肝脏血肿的原因及防治策略。方法 选取2016年6月~2020年11月我院新生儿重症监护病房实施UVC
置管术后1239例中4例发生肝损伤患儿的临床资料，包括性别、胎龄、出生体重、UVC置管留置时间、置管深度、管端位
血肿经穿刺引流,1例肝血肿自行吸收,肝脏超声复查显示不均质回声区均消失。随访4例患儿至纠正年龄6个月，一般
情况良好。结论 新生儿UVC置管术后肝血肿与UVC管端X线摄影定位位置不理想、导管保留时间过长及输注高渗性
药物等因素有关，建议UVC置管术后行超声检查确定UVC置管管端位置，给予管路集束化护理对策，严密观察患儿病情
基金项目：山东省重点研发计划项目(编号：2018GSF118163)9) 作者简介:张君(1983-),女，山东泰安人，毕业于山东大学护理学院，护理硕士，主管护师，主要从事新生儿重症护理工作 通信作者:沈清清 副主任护师E-mail：28709555@qq. com
医学影像学杂志2021年第31卷第6期 J Med Imaging Vol. 31 No. 6 2021
新生儿uvc置管术后肝脏血肿原因分析及防治策略
张君1 ,于玲2 ,沈清清1 ,王立俊I 1.山东第一医科大学附属省立医院新生儿科山东济南250021；2.山东省第二人民医院(山东省耳鼻喉医院)妇产科山东济南
置良好，管端位置均在T10椎体上下(横膈下0. 5 ~ 1 cm)。按照新生儿科脐静脉置管护理规范给予脐 静脉管路集束化护理对策，每日晨给予脐部换药1 次,观察置管处敷料是否干燥,如有渗血渗液随时更
换;严格执行消毒隔离措施及手卫生规范;输液连接
装置每24 h更换;每班严格交接脐静脉管路外露刻 度;妥善固定管路，防止非计划性拔管发生;每6 h 冲管评估管路通畅情况⑶0置管后6~11天由于患 儿黄疸、腹胀、反应差、临床感染指标升高等不同原 因行腹部超声检查，发现4例患儿UVC均异位至肝 区，超声提示肝脏大小混杂不均质回声区，无明显血 流信号，考虑UVC导致肝脏血肿，见表2。
vember 2020, 1239 neonates were subjected to our hospital neonatal intensive care unit to implement UVC catheter, in whom 4 cases occurred the liver hematoma postoperatively. In this work, the clinical data of those 4 cases, including gender, gestational age, birth weight, UVC catheter indwelling time and the depth of insertion, tube end position, catheter after occurring the clinical manifestation and prognosis of liver hematoma, and so forth, were retrospectively analyzed. Results Hepatic hematoma occmred in 4 cases after UVC catheterization, with an incidence of 0. 32% . Among the 4 cases, liver abscess was formed by hematoma in­ fection in 1 case, and liver hematoma in 3 cases. For the characteristics of the four cases of liver damage in children with postop­ erative UVC, all were given positioning bedside X 一 ray photography and cluster nursing strategy and symptomatic treatment. After UVC, 4 cases presented with jaundice, abdominal distention, poor response, clinical infection index rise leading to abdominal ul­ trasound examination. We found that all ectopic to liver area UVC, ultrasonic tip liver heterogeneity echo area, without obvious blood flow signal. All of those 4 cases were immediately removed after ultrasound examination and treated with antibiotics and antiinfiection treatment. The effect of anti-infection treatment was poor in 1 case. Ultrasound-guided puncture revealed that the punc­ ture fluid was positive for pus blood culture, and the lesions gradually shrank after effective anti-infection treatment. 2 cases of liv­ er hematoma were absorbed by puncture and drainage, and 1 case was self 一 absorbed by liver hematoma. The patients were fol­ lowed up until the correction age o£ 1 year, and the general condition was good. Conclusion Neonatal UVC catheter postopera­ tive hepatic hematoma with UVC tube X-ray locating position is not ideal, which is related to long time of catheter retention is too
顾性分析我科自2016年6月~2020年11月1 239 例行UVC置管术患儿，发现术后肝血肿4例。总结 其临床表现、影像特点，讨论UVC置管致肝血肿原
因及防治策略，为临床提供治疗护理思路 。
1资料与方法
1.1 一般资料 选取2016年6月~2020年11月于我院新生儿
重症监护病房行UVC置管的新生儿1 239例，经腹 部超声证实并发肝损伤4例，其中肝脓肿1例，肝血 肿3例。男性3例，女性1例，胎龄29 +4 ~ 34 “周， 平均胎龄(32.2±2.2)周。出生体重1 500 ~2 300 g,平均体重(1 870 ±328) go 4例患儿初始置管深 度为8~9 cm,行床边标准X线摄影检査定位导管 尖端位置在T10 ~T11,4例患儿均由UVC匀速泵入 肠外营养液，见表1。本文经医院伦理委员会通过。
China 2. Department of Gynaecology and Obstetrics, Shandong Second Provincial General Hospital, Shandong Provincial ENT Hospital, Jinan 250021, P. R. China
病例 1 2 3 4
表2 4例患儿UVC置管后临床表现、感染指标、影像学特点
[Abstract] Objective The causes and prevention strategies of UVC-complicated liver hematoma were discussed from the clini­ cal manifestations and imaging characteristics after umbilical vein catheterization in neonates. Methods From June 2016 to No­
变化，及时发现，尽早处理。
【关键词】新生儿;脐静脉置管;肝血肿/脓肿;X线摄影;超声检查
中图分类号:R722.1;R814.3;R445.1
文献标识码:A
文章编号：1006-9011 (2021 )06-1006-05
Cause analysis and prevention strategy of hepatic hematoma after UVC catheterization ZHANG Jun , YU Ling , SHEN Qingqing , WANG Lijun1 1. Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, P. R.
置、置管后发生肝脏血肿的临床表现及预后等。结果实施UVC置管术后的患儿发生肝脏血肿4例，发生率为0.32% ,4
例中血肿感染形成肝脓肿1例,肝血肿3例。4例患儿均行床旁胸腹联合X线摄影正位定位，给予UVC置管管路集束化
护理对策及对症治疗;1例超声引导下穿刺发现穿刺液为脓液,血培养阳性，给予有效抗感染治疗后病灶逐渐缩小;2例肝