Impact of Temperature Intervention on Pain and Catheterization Outcomes in Premature Infants Undergoing PICC Placement
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摘要:
目的 探究温度干预对早产儿经外周静脉置入中心静脉导管（peripherally inserted central catheter，PICC）疼痛及置管效果的影响。 方法 选取2023年1月至2023年12月于云南省昆明市某三级甲等儿童专科医院新生儿科住院的70例PICC置管且符合纳入标准的早产儿作为研究对象，运用随机数字表法分为对照组（n = 35）和观察组（n = 35）。对照组按常规PICC置管流程进行；观察组在对照组的基础上实施了温度干预措施，即使用加温至37 ℃的碘伏消毒、借助辐射台温度温暖操作者双手热敷置管部位、使用加温至37 ℃的生理盐水配合送管及皮肤清洁。比较两组早产儿PICC置管中消毒、穿刺、送管、清洁时早产儿疼痛评分量表（premature infant pain profile，PIPP）评分、血氧饱和度、心率、一次性穿刺和一次性送管成功率、并发症发生率、置管后低体温发生率。 结果 观察组在PICC置管中消毒、穿刺、送管、清洁的PIPP评分均低于对照组（P < 0.05）；置管中观察组血氧饱和度平均值高于对照组，差值低于对照组（P < 0.05）；置管中观察组心率差值和平均值均低于对照组（P < 0.05）；观察组PICC置管时一次性穿刺和一次性送管成功率、置管后低体温发生率均低于对照组（P < 0.05），两组并发症发生率比较，差异无统计学意义（P > 0.05）。 结论 早产儿PICC置管时实施温度干预可有效减轻患儿疼痛，维持生命体征稳定，提高一次性穿刺和送管成功率，有效预防低体温的发生率。 Abstract:Objective To investigate the impact of temperature intervention on pain and catheterization outcomes in premature infants undergoing peripherally inserted central catheter （PICC） placement. Methods A total of 70 premature infants who underwent PICC placement and met the inclusion criteria were selected from the Neonatology Department of a tertiary children's hospital in Kunming, Yunnan, from January 2023 to December 2023. They were randomly divided into a control group （n = 35） and an observation group （n = 35） using a random number table. The control group underwent the standard PICC placement procedure; the observation group underwent temperature intervention measures based on the control group, which included using iodine tincture warmed to 37 ℃ for disinfection, applying warm compresses to the catheterization site with heated hands of the operator, and using saline warmed to 37 ℃ during catheter insertion and skin cleansing. Pain scores measured by the Premature Infant Pain Profile （PIPP）, blood oxygen saturation, heart rate, success rates of single puncture and single catheter insertion, incidence of complications, and occurrence of hypothermia post-catheterization were compared between the two groups. Results The PIPP during disinfection, puncture, catheter insertion, and cleansing were significantly lower in the observation group than in the control group （P < 0.05）; the average blood oxygen saturation in the observation group was higher than that in the control group, with a lower difference compared to the control group （P < 0.05）; the difference and average heart rate during catheterization in the observation group were both lower than those in the control group （P < 0.05）; the success rates of single puncture and single catheter insertion, as well as the incidence of hypothermia post-catheterization in the observation group, were both lower than those in the control group （P < 0.05）, while the comparison of complication rates between the two groups showed no statistically significant difference （P > 0.05）. Conclusion Implementing temperature intervention during PICC placement in premature infants can effectively reduce pain, maintain stable vital signs, improve the success rates of single puncture and catheter insertion, and effectively prevent the incidence of hypothermia. -
Key words:
- Temperature intervention /
- Premature infants /
- PICC placement /
- Pain /
- Catheterization outcomes
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表 1 一般资料比较[n（%）/（$ \bar x \pm s $）/ M（P25，P75）]
Table 1. General information comparison[n（%）/（$ \bar x \pm s $）/ M（P25，P75）]
组别 性别 胎龄（周） 置管日龄（d） 置管体重（kg） 男 女 对照组（n=35） 22（62.9） 13（37.1） 32.59±2.06 5.00（2.50，6.50） 1.70±0.33 观察组（n=35） 20（57.1） 15（42.9） 32.78±2.12 4.00（2.50，6.50） 1.67±0.34 χ2/t/Z 0.238 −0.383 −0.209 0.378 P 0.626 0.703 0.834 0.706 
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表 2 PIPP评分比较[（$ \bar x \pm s $，分）]
Table 2. Comparison of PIPP scores [（$ \bar x \pm s $），score]
组别 n 消毒 穿刺 送管 清洁 对照组 35 11.57±2.34 14.49±1.20 9.97±1.36 6.40±1.52 观察组 35 8.74±2.45 12.03±1.69 8.09±1.79 4.77±1.40 t 4.832 7.022 4.964 4.672 P <0.001* <0.001* <0.001* <0.001* *P < 0.05。
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表 3 血氧饱和度、心率比较（$ \bar x \pm s $）
Table 3. Comparison of blood oxygen saturation and heart rate（$ \bar x \pm s $）
组别 n 置管前1 h血氧饱和度 置管前1 h心率 置管中血氧饱和度 置管中心率 差值 平均值 差值 平均值 差值 平均值 差值 平均值 对照组 35 9.26±2.66 93.40±1.83 31.71±7.20 145.86±6.77 15.11±2.95 89.03±2.19 45.03±8.02 156.17±6.69 观察组 35 9.86±3.16 93.31±2.01 33.66±7.75 145.17±7.28 12.66±3.35 90.86±2.13 40.66±6.91 152.29±6.93 t −0.859 0.186 −1.087 0.408 3.257 −3.541 2.443 2.387 P 0.394 0.853 0.281 0.685 0.002* 0.001* 0.017* 0.020* *P < 0.05。
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表 4 一次性穿刺和一次性送管成功率比较[n（%）]
Table 4. Comparison of success rates for single-puncture and single-tube delivery[n（%）]
组别 n 一次性穿刺成功 一次性送管成功 是 否 是 否 对照组 35 20（57.1） 15（42.9） 22（62.9） 13（37.1） 观察组 35 28（80.0） 7（20.0） 30（85.7） 5（14.3） χ2 4.242 4.786 P 0.039* 0.029* *P < 0.05。
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表 5 低体温发生率比较[n（%）]
Table 5. Comparison of incidence of hypothermia[n（%）]
组别 n 是 否 对照组 35 11（31.4） 24（68.6） 观察组 35 4（11.4） 31（88.6） χ2 4.158 P 0.041* *P < 0.05。
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表 6 并发症比较[n（%）]
Table 6. Comparison of complications[n（%）]
组别 n 静脉炎 导管相关血流感染 穿刺点感染 对照组 35 5（14.3） 1（2.9） 0（0.0） 观察组 35 5（14.3） 1（2.9） 1（2.9） χ2 1.245 P 1.000
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