血液透析患者颈内静脉穿刺插管过程中心律失常分析  

Studies of cardiac arrhythmias during catheterization through internal jugular vein in hemodialysis patients

作　　者：王新文[1] 陈浩[1] 李文宏[1] 杜艾蛟[1] 乔丽[1] 王晋文[1] 

机构地区：[1]云南省昆明市延安医院血液净化中心,昆明661000

出　　处：《中国血液净化》2013年第2期63-65,共3页Chinese Journal of Blood Purification

摘　　要：目的观察血液透析患者颈内静脉穿剌置管过程中心律失常的发生情况及相关影响因素。方法选择昆明市延安医院血液净化中心2010年以来需要行颈内静脉穿剌插管的血液透析患者100例,在穿剌前、穿剌过程中应用心电监护仪观察患者心律失常情况并实时记录,收集患者一般资料及血气分析、电解质、肾功能情况,观察局部麻醉效果、穿剌是否顺利、穿剌导丝进入长度情况,分析心律失常与相关观察因素的关系。结果 29/100(29%)在穿剌过程中出现心律失常,心律失常的发生与导丝进入血管的长度有关(P<0.05),而与年龄、身高、局部麻醉效果、穿剌顺利与否及电解质、PH值、动脉氧分压、氧饱和度等无关。心律失常多表现为房性及室性早博,以房性早博多见。结论血液透析患者颈内静脉穿剌插管过程中有较高的心律失常发生率,而心律失常的发生与导丝过深插入有关,避免过度插入导丝可减少心律失常的发生。Objectives To observe the incidence and the related factors of arrhythmias during internal jugular vein catheterization in hemodialysis patients. Methods Atotal 100 cases subjected to central vein catheterization via internal jugular vein in our hospital from January 2010 to June 2012 were selected. Arrhythmias were recorded by ECG monitor during the catheterization processes. General information of the patients, blood gas, electrolytes, renal function, the effect of local anesthesia, the success rate of puncture, and the length of inserted guide wire were collected and analyzed with arrhythmias. Results During the puncture period there were 29 cases occurring arrhythmias, which were related to the length of inserted guide wire （P 〈 0.05）, but were unrelated to age, height, the effect of local anesthetic, the success rate of puncture, electrolytes, pH value, PO2 and SPO2. Arrhythmias were predominantly atrial and ventricular premature beats, especially atrial premature beats. Conclusions The incidence of arrhythmias during internal jugular vein Catheterization is higher in hemodialysis patients, which is closely related to the over deep insertion of guide wire. Appropriate insertion of guide wire will reduce the incidence of arrhythmias.

关 键 词：血液透析 颈内静脉 心律失常 导管 

分 类 号：R318.16[医药卫生—生物医学工程]