超声引导经锁骨下静脉置入植入式输液港的效果  

Correct placement of the tip of central venous catheter In the vena cava and right atrium through subclavian vein under ultrasound guidance

作　　者：陈文发[1] 公维义[1] 陈华[1] 林鹏涛[1] 张良成[1] 

机构地区：[1]福建医科大学附属协和医院麻醉科,福州市350001

出　　处：《中华麻醉学杂志》2010年第3期285-287,共3页Chinese Journal of Anesthesiology

摘　　要：目的 探讨应用超声引导定位在经锁骨下静脉人路置入植入式输液港的效果.方法 选择乳腺癌患者60例,年龄28～63岁,体重41～70 kg,身高150～168 cm,ASA Ⅰ或Ⅱ级,拟经锁骨下静脉穿刺置入植入式输液港行长期输液及化疗,输液港导管尖端位置应在上腔静脉和右心房交界处.随机分为2组（n=30）：对照组（C组）经锁骨下静脉穿刺,采用脉冲注射冰盐水实验的方法引导定位植入式输液港导管尖端位置.超声组（U组）经锁骨下静脉穿刺,采用超声引导定位植入式输液港导管尖端位置.所有患者术后均经过X线摄片进行导管定位.计算两组患者首次置入成功率.结果 U组患者术后X线摄片显示输液港导管尖端均在上腔静脉和右心房交界处,未发生导管偏离进入颈内静脉的现象,首次置入成功率100%.C组术后X线摄片显示有6例患者的输液港导管发生了偏离,进入颈内静脉,需回手术室在超声引导定位下重新穿刺置管,首次置入成功率80%.U组首次置入成功率高于C组（P〈0.05）.结论 超声引导定位是经锁骨下静脉正确放置植入式输液港的有效手段.Objeetlve To avoid inserting the tip of the central venous catheter into internal jugular vein （IJV） through subclavian vein under ultrasound guidance.Methods sixty breast cancel patients aged 28-63 yr weighing 41-70 kg who needed long-term intravenous infusion and chemotherapy through central venous catheter were randomly divided into 2 groups （n=30 each）：control group （group C） and ultrasound group （group U）.In group C the insertion of central venous catheter through subclavian vein was guided by pulsatile injection of ice-cold saline.In group U ultrasound detector （type HFL 38/13-6 MH,Sonosite Co,USA） was used to guide the insertion of tbe central vesons catheter.The position of the catheter tip was verified by X-ray radiography.The rate of successful placement at 1st attempt was calculated.Results The tip of the central venous catheter was correctly placed in the vena cava and right atrium in all patients in group U （success rate 100%）,while in group C the tip was misplaced in IJV in 6 patients （success rate 80%） and had to be replaced.Conclusion Ultrasound guidance is effective for correct placement of the tip of central venous catheter in the vema cava and right atrium through subclavian vein.

关 键 词：超声检查 多普勒 锁骨下静脉 输注 静脉内 

分 类 号：R473.73[医药卫生—护理学]