凝血酶冻干粉联合压迫止血器在老年患者PICC穿刺点渗血中的应用研究

doi:10.3969/j.issn.1003-9198.2026.01.021

摘要/Abstract

摘要： 目的研究不同止血方法对老年患者经外周静脉置入中心静脉导管(PICC)穿刺点渗血的影响。方法回顾性选择2022年4月至2024年4月在南京医科大学附属老年医院置入PICC的老年患者150例,按照止血方法分成凝血酶组(n=75)和常规组(n=75)。凝血酶组置管后使用凝血酶冻干粉覆盖穿刺点,并使用压迫止血器局部加压15 min;常规组置管后常规固定导管,穿刺点使用压迫止血器局部加压15 min。比较2组间并发症的发生率。结果与常规组比较,凝血酶组置管后24 h出血量明显减少,穿刺点持续渗血时间显著缩短,7 d换药次数显著降低,差异均有统计学意义(P＜0.05)。2组穿刺点均未发生感染。结论老年患者PICC置管后穿刺点覆盖凝血酶冻干粉可以有效降低渗血量及持续渗血时间,减少导管维护次数,减轻患者经济负担,提高临床护士的工作效率。

关键词: 凝血酶冻干粉, 压迫止血器, 经外周静脉置入中心静脉导管, 渗血, 老年人

Abstract: Objective To investigate the effect of different hemostatic methods on bleeding from PICC puncture site in the elderly patients. Methods A total of 150 elderly patients who underwent PICC placement at the Affiliated Geriatric Hospital of Nanjing Medical University from April 2022 to April 2024 were enrolled. Based on hemostatic methods, the patients were divided into the thrombin group (n=75) and the regular group (n=75). In the thrombin group, lyophilized thrombin powder was applied at the puncture site post-insertion, followed by catheter fixation and local compression with the hemostatic device for 15 minutes. The regular group received catheter fixation and compression with the hemostatic device for 15 minutes without thrombin powder. The incidence rate of complications was compared between the two groups. Results Compared with the regular group, the bleeding volume 24 h after insertion, duration of persistent puncture site bleeding, and the number of dressing changes within 7 d in the thrombin group were significantly reduced (all P<0.05). No infections were observed at the puncture sites in either group. Conclusions Application of lyophilized thrombin powder at the PICC puncture site in the elderly patients can effectively reduce post-procedural bleeding volume and duration, decrease catheter maintenance frequency, alleviate patients’ financial burden, and enhance clinical nursing efficiency.

Key words: lyophilized thrombin powder, compression hemostatic device, peripherally inserted central catheter, bleeding, aged

中图分类号:

R 472.9

柏健, 蔡崔春, 王久林, 俞笠, 胡彧波, 王仕芳, 刘小芹. 凝血酶冻干粉联合压迫止血器在老年患者PICC穿刺点渗血中的应用研究[J]. 实用老年医学, 2026, 40(1): 104-108.

BAI Jian, CAI Cuichun, WANG Jiulin, YU Li, HU Yubo, WANG Shifang, LIU Xiaoqin. Application of lyophilized thrombin powder and compression hemostatic device in bleeding from PICC puncture site in elderly patients[J]. Practical Geriatrics, 2026, 40(1): 104-108.

参考文献

[1] SCHEARS G J, FERKO N, SYED I, et al. Peripherally inserted central catheters inserted with current best practices have low deep vein thrombosis and central line-associated bloodstream infection risk compared with centrally inserted central catheters: a contemporary meta-analysis[J]. J Vasc Access, 2021, 22(1): 9-25.
[2] 黄家莲, 应燕萍. 癌症患者经外周静脉置入中心静脉导管相关性血栓的研究进展[J]. 广西医学, 2018, 40(7): 829-832.
[3] 杨婧诗, 邹立群. 淋巴瘤相关静脉血栓的影响因素及风险评估模型的研究进展[J]. 中国全科医学, 2021, 24(23): 2992-2997.
[4] 虎洁婷. 9种敷料预防PICC穿刺点渗血效果的网状Meta分析[J]. 护理研究, 2021, 35(2): 231-239.
[5] 刘志梅, 郑焠燕. 藻酸盐敷料和明胶海绵敷料对老年患者PICC置管后渗血及感染的护理效果[J]. 中华医院感染学杂志, 2023, 33(19): 3033-3036.
[6] 王利, 孙新, 戴俭慧, 等. 银离子藻酸盐敷料在经MST行PICC置管后患者中的应用[J]. 护理实践与研究, 2016, 13(1): 144-145.
[7] 郭娟, 曹伟杰, 张素平, 等.老年急性白血病患者化疗期间发生PICC相关血流感染风险预测模型的构建与验证[J].中华现代护理杂志, 2024, 30(11):1489-1496.
[8] 魏敏, 张嘉, 崔育花, 等. 医用组织胶对减少PICC穿刺部位渗血的应用效果观察[J]. 蚌埠医学院学报, 2022, 47(11): 1614-1616.
[9] 赵爱琳, 张瑜. 纽扣式血透压脉带联合明胶海绵在耐高压双腔PICC止血中的应用[J]. 护理学杂志, 2014, 29(4): 51-52.
[10] LARSEN J B, HVAS A M. Thrombin: a pivotal player in hemostasis and beyond[J]. Semin Thromb Hemost, 2021, 47(7): 759-774.
[11] CARDENAS J C. Thrombin generation following severe trauma: mechanisms, modulators, and implications for hemostasis and thrombosis[J]. Shock, 2021, 56(5): 682-690.
[12] MARAR T T, MATZKO C N, WU J, et al. Thrombin spatial distribution determines protein C activation during hemostasis and thrombosis[J]. Blood, 2022, 139(12): 1892-1902.
[13] 李蓉梅, 袁玲, 周玉洁. 钝性分离法在改良赛丁格技术PICC置管中的应用[J]. 护理学杂志, 2016, 31(9): 63-64.
[14] 冯丽娟, 余琪, 孙杉杉, 等. 组织胶水在白血病血小板低下病人PICC置管中的应用[J]. 护理研究, 2021, 35(12): 2251-2253.
[15] 国家卫生健康委员会. 静脉治疗护理技术操作标准: WS/T 433—2023[S]. 北京: 化学工业出版社, 2017.
[16] GORSKI L A. Update: the 2024 infusion therapy standards of practice[J]. Home Healthc Now, 2024, 42(4): 198-205.
[17] 国家卫生健康委办公厅医政医管局. 血管导管相关感染预防与控制指南(2021版)[J]. 中国感染控制杂志, 2021, 20(4): 387-388.
[18] 叶凯丽, 黄素黄, 叶云霞, 等. 环臂式沙袋对PICC穿刺后渗血的预防效果[J]. 中国乡村医药, 2021, 28(9): 5-6.
[19] 王莉. 自制弹力绷带用于PICC置管后的止血效果观察[J]. 护士进修杂志, 2012, 27(2): 176-177.
[20] 黄芬, 章洁苓, 范彬, 等. 气囊式创口贴在预防血小板低下患者PICC置管后出血的效果研究[J]. 实用临床医学, 2019, 20(12): 75-76, 94.
[21] GORSKI L A, HADAWAY L, HAGLE M E, et al. Infusion Therapy Standards of Practice, 8th Edition[J]. J Infus Murs, 2021, 44 (1S Suppl 1): S1-S224.
[22] 吴吉敏, 闫琼, 徐海英, 等. 新型功能性止血敷料在PICC置管后持续渗血者中的应用进展[J]. 中国医疗器械杂志, 2025, 49(2): 169-175.
[23] IBNE MAHBUBM S, SULTANA T, GWON J G, et al. Fabrication of thrombin loaded TEMPO-oxidized cellulose nanofiber-gelatin sponges and their hemostatic behavior in rat liver hemorrhage model[J]. J Biomater Sci Polym Ed, 2022, 33(4): 499-516.
[24] 何松峡, 苏炜, 魏鹏.老年股骨转子间骨折髓内固定术中局部应用凝血酶对术后失血量的影响研究[J].中华创伤骨科杂志, 2024, 26(6):493-498.
[25] 高显奎, 赵太云, 陆兴俊, 等. 奥美拉唑联合凝血酶治疗上消化道非静脉曲张出血患者的临床研究[J]. 中国临床药理学杂志, 2023, 39(15): 2140-2144.
[26] 陈国雁, 冯晓波, 尚精娟, 等. 凝血酶冻干粉联合奥美拉唑治疗消化道溃疡出血的临床效果及纤维蛋白原变化探讨[J]. 哈尔滨医科大学学报, 2020, 54(4): 440-442.
[27] 谭敦勇, 郭嘉炜, 邓志钦, 等. 壳聚糖敷料促进创面愈合的研究进展[J]. 生物骨科材料与临床研究, 2025, 22(1): 70-75, 81.
[28] 赵艳, 秦昌富. 不同程度血小板减少患者中心静脉置管的临床护理研究[J]. 中国医药导报, 2016, 13(14): 138-140, 145.