| Objective:To explore the application effect of local anesthesia of Lidocaine injection combined with compound lidocaine cream applied externally in children with blood malignant tumor above 4 years old to perform PICC catheterization using modified sedentine technique,so as to better reduce the pain caused by catheterization in children and provide basis for clinical promotion.Methods:In this study,children with hematologic malignancies aged 4 years or above requiring PICC catheterization who visited the hematology department of a Third-grade A hospital in Jiangxi Province from May 2019 to August 2020 were selected as the research objects.according to the order of insertion were randomly divided into lidocaine injection group(hereinafter referred to as injection group),the compound lidocaine cream group(hereinafter referred to as cream group)and lidocaine injection combined compound lidocaine cream group(hereinafter referred to as the joint group),30 cases in each group.In the injection group,conventional local anesthesia was used for PICC catheterization with improved sedingg technique,that is,lidocaine injection was used for subcutaneous injection of local anesthesia before skin rupture after puncture of blood vessels.Before catheterization in the cream group,local external application of compound lidocaine cream was performed on the skin at the side of catheterization for 60 min,and then the cream was cleaned with warm water before catheterization.The combined group combined with the local anesthesia of the injection group and the cream group,the cream was applied externally before catheterization,and the local anesthesia of lidocaine injection was administered in the catheter.The general data,pain scores at 4 pain points in the catheterization,success rate of one-time catheterization,completion time ofcatheterization,complications after catheterization,and changes in blood pressure and heart rate before and after catheterization were compared among the three groups.Result:1.General information of children in the three groups: gender,age,arm circumference,catheter placement site,catheter length in vitro and in vivo were not statistically significant(P > 0.05),that is,the baseline data of the three groups were comparable and comparable.2.The pain score(score)in the catheterization of children in the three groups was non-normal distribution,represented by median and quartile.Injection group puncture blood vessel 5.00(3.00,5.25),subcutaneous local anesthesia 7.00(5.00,7.00),blade puncture skin 3.00(3.00,4.00),vascular sheath 3.00(3.00,4.00);In the cream group,the blood vessel puncture was 3.00(2.00,4.25),the skin puncture of the blade was 4.00(3.00,5.00),and the vascular sheath was 5.00(4.00,5.00).In the combined group,the puncture vessel was 3.00(2.00,4.00),subcutaneous local anesthesia was 3.00(2.00,3.00),broken skin was 2.00(2.00,3.00),and vascular sheath was 2.00(2.00,3.00).Compared with the cream group,the pain score of the injection group was better than that of the cream group(P=0.039,0.003)when breaking skin and inserting vascular sheath.The pain score of the cream group was better than that of the injection group(P=0.003).Compared with the injection group and the cream group,the pain score of each point in the combination group was better than that of the latter two groups.The above differences were statistically significant(all P < 0.05).3.The success rates of one-time catheterization were 53.3% for injection group,50.0% for cream group and 83.8% for combination group,respectively.There was no statistically significant difference between the injection group and the cream group(P=0.796).The success rate of one-time catheterization in the combined group was much higher than that in the injection group and the cream group,with statistically significant difference(P=0.012,0.006).4.The completion time(min)of intubation was 21.30(18.60,26.50)in the injection group,24.75(20.52,27.92)in the cream group,and 18.50(17.20,20.22)in the combination group.There was no statistically significant difference between the injection group and the cream group(P=0.267),and the completion time of the combination group was better than that of the injection group and the cream group,with statistically significant difference(P=0.003 and 0.000).5.The incidence of complications after catheterization was 23.3% in the injection group,20.0% in the cream group,and 13.3% in the combination group,respectively.There was no statistically significant difference between the three groups(P=0.706).6.The systolic blood pressure difference(mm Hg)between the three groups before and after catheterization was 13.33±6.75 in the injection group,18.23±6.03 in the cream group and 8.53 ± 4.09 in the combination group,respectively.The diastolic blood pressure differences were 11.20±6.32 in the injection group,15.80±4.96 in the cream group and 7.73 ± 4.79 in the combination group.The values of systolic and diastolic blood pressure in the injection group were both better than those in the cream group,and the combined group were both better than those in the injection group,with statistically significant differences(all P < 0.05).7.The heart rate difference(times /min)before and after catheterization was12.77 ± 5.16 in injection group,16.17 ± 4.44 in cream group and 9.30 ± 5.35 in combination group,respectively.The heart rate difference of the injection group was better than that of the cream group,and the systolic and diastolic blood pressure difference of the combined group was better than that of the injection group,and the difference was statistically significant(all P < 0.05).Conclusion:Topical application of lidocaine injection combined with compound Lidocaine cream in PICC catheterization with improved sedentgen technology in children can effectively relieve the pain stimulation brought by catheterization,improve the success rate of one-time catheterization,shorten the completion time of catheterization,and stabilize the physiological indexes.for children with subsequent treatment and confidence to conquer the disease plays a positive role,suitable for clinical use. |
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