超声引导中心静脉穿刺置管的临床评价  

Clinical evaluation of ultrasound-guided technique for central venous catherization

作　　者：郑颖[1] 周子戎 汪春英[1] 张爱萍[1] 闻大翔[2] 黄贞玲[2] 杭燕南[2] 

机构地区：[1]上海市黄浦区中心医院麻醉科,200002 [2]上海交通大学医学院附属仁济医院麻醉科

出　　处：《上海医学》2007年第7期504-506,共3页Shanghai Medical Journal

摘　　要：目的评价超声显像定位引导中心静脉穿刺置管的临床实用性和安全性。方法960例拟实施中心静脉穿刺置管的患者,随机均分为对照组(采用常规体表定位中间入路颈内静脉穿刺置管)和超声组(采用超声诊断定位技术,根据显示的颈内静脉确切位置行纵向体表定位后进行穿刺)。结果超声组一次穿刺成功424例(88.3%),二次(以上)成功54例(11.3%),穿刺失败2例(0.4%),总成功率为99.6%;对照组一次穿刺成功298例(62.1%),二次(以上)成功131例(27.3%),穿刺失败51例(10.6%),总成功率为89.4%;两组一次穿刺成功率和穿刺失败率的差异均有统计学意义(P值分别<0.05、0.01)。超声组的穿刺时间为(3.0±2.5)min,明显短于对照组的(9.5±3.5)min(P<0.01)。超声组无一例出现血肿,对照组为13例(2.9%,P<0.01);超声组无一例出现臂丛神经异感,对照组为2例(0.4%,P>0.05)。超声组发现解剖变异8例(1.7%),颈内静脉位于胸锁乳突肌锁骨头外侧,均在超声显像定位后穿刺成功。结论超声引导下行中心静脉穿刺置管简便、安全,成功率高,并发症少,可缩短穿刺时间,减少危重患者的体位不适以及疾病和穿刺带来的风险,尤其对于穿刺困难的患者,有重要的临床实用价值且安全、可靠。Objective To assess the clinical value and safety of ultrasound-guided technique for central venous catherization. Methods Nine hundred and sixty patients requiring central venous catherization were allocated randomly to control group （n = 480） and ultrasound-guided group （n = 480）. Punctures of the internal jugular vein in the control group were performed by traditional technique; whereas punctures in the ultrasoundguided group were performed with the exact location of the internal jugular vein by ultrasonic imaging method. Results （1） The rate of success： in the ultrasound guided group, 424 cases succeeded at the first puncture （88.3%）, 54 cases exceed two attempts（11. 3%）, 2 cases failed（0.4%）, the rate of success was 99.6% overall. In the control group, 298 cases succeeded at the first puncture （62. 1%, P 〈 0. 05）, 131 cases exceeded two attempts（27.3%）, 51 cases failed （10.6%, P 〈 0.01）, the rate of success was 89.4% overall. （2）The time of puncture： the ultrasound-guided group required less time for successful cannulation [（3.0 ± 2.5） mini less than the control group [（9.5 ± 3.5） min, P 〈 0.01]. （3）Complications： none had hematoma in ultrasound-guided group and 13 cases （2.9%） in the control group （P 〈 0.01） ; none had brachial plexus paresthesia in ultrasoundguided group and 2 cases in the control group. （4）Anatomical variation： in ultrasound guided group, the internal jugular veins were situated externally to the clavicular head of sternocleidomastoideus muscule in 8 cases（1.7% ） which were performed successfully by ultrasonic imaging method. Conclusion Guidance with ultrasonic imaging method for central venous catherization is＂ an easy and safe technique with high successful rate and fewcomplications, furthermore, it can reduce the risk for ritical patients, there by having infratant and practical value in particular for those ＂difficult sticks＂.

关 键 词：超声引导 中心静脉置管术 成功率 并发症 

分 类 号：R445.1[医药卫生—影像医学与核医学]