经锁骨下中心静脉置管机械性并发症分析及对策探讨  

The analysis and countermeasures of the mechanical complication of central vein catheterization through subclavian vein puncture

作　　者：孙雪琴 何续逊 夏月琴 朱红梅 

机构地区：[1]江苏省盐城市肿瘤医院,224003

出　　处：《中国医学创新》2009年第35期30-32,共3页Medical Innovation of China

基　　金：江苏省盐城市医学科技发展计划项目(YK2004060)

摘　　要：目的避免或减少经锁骨下中心静脉插管(CVC)的机械性并发症。方法经锁骨下中心静脉穿刺插管,并系统观察所有并发症,进而分类统计、分析。结果共穿刺2053例,置管成功2039例(99.32%)。机械性并发症依次为:点滴不畅、导管滑脱各43例(2.11%),误刺锁骨下动脉33例(1.62%),局部渗血23例(1.13%),导管误入颈内或颈总或颈前静脉共14例(0.69%),血液反流至导管内8例(0.39%),气胸5例(0.25%),导管阻塞、导管内移各3例(0.15%),误刺淋巴管2例(0.10%),拔管困难及拔管时出血各1例(0.05%),均经相应处理痊愈。结论经锁骨下中心静脉插管机械性并发症种类虽多,但每种发生率较低且经相应处理多可缓解,不影响使用,提高穿刺技能并主动干预多可避免或大幅度减少机械性并发症的发生。Objective To reduce or avoid the mechanical complications of central vein catheterization （CVC） through subclavian vein puncture. Methods To observe all of the complications of CVC through subclavian vein puncture. Results Of 2039 patients with successful CVC, 43 cases （2.11% ） were with poor intravenous drip and olisthy of the catheters,33（ 1.62% ） were puncted into subclavian artery by mistake, 23 （1.13 % ） were with partis erhysis, 14 （0.69%） were puncted into internal jugular vein or common jugular vein or external jugular vein, 8（0.39% ） were with blood regurgitated into the catheters, 5 （0.25%） were with pneumothorax, 3 （0. 15% ） were with catheters obstraction and inghression, 2 （0.10%） were puncted into lymphatic vessel, 1 （0.05%） was difficult to pull out and 1 （0.05%） was bleeding when pulling. All of the complications were healed well. Conclusion Although there are many mechanical complications in CVC,but the incidence rate of them is low and they can be healed well. The complication can be avoided or reduced greatly by improving the skill of puncture and more initiative intervention.

关 键 词：中心静脉插管 经锁骨下穿刺 并发症 防治对策 

分 类 号：R459.7[医药卫生—急诊医学]