右心房心电图引导下锁骨下静脉置管技术的临床观察结果  

A Clinical Observation of Right-artrial ECG Guided Subclavicular Vein Catheter Technique

作　　者：卢文江 范丹[2] 兰志勋[2] 徐广民[2] 邓佳[2] 

机构地区：[1]乐山市人民医院麻醉科,四川乐山614000 [2]四川省人民医院麻醉科,四川成都610072

出　　处：《四川医学》2014年第4期461-463,共3页Sichuan Medical Journal

摘　　要：目的评价右心房心电图(right-artrial ECG,RAECG)引导与常规技术(convenitiional placement techniques,CT)行右锁骨下静脉穿刺导管尖端位置的到位率及其他不良反应。方法 40例择期行全身麻醉的骨科手术患者,经数字随机表均分为2组,分别接受右心房心电图引导右锁骨下中心静脉置管技术(A组,n=20)、传统常规右锁骨下静脉置管技术(B组,n=20),穿刺结束即刻通过C臂或床旁X-胸片观察导管的走向,记录各组患者导管尖端位置,导管平均置入深度以及导管异位情况。结果 A组患者导管尖端位于上腔静脉18例,2例异位于右颈内静脉,导管位置精确率90%,B组患者导管尖端位于上腔静脉14例,6例异位于右颈内静脉,导管位置精确率70%,两组间比较差异有统计学意义(P<0.05);A组患者导管置入平均深度(11.3±1.2)cm,B组患者导管置入平均深度(14.45±1.6)cm,两组间比较差异有统计学意义(P<0.05);两组间穿刺时间、误穿动脉、气胸等不良反应发生率比较差异无统计学意义(P>0.05)。结论右心房心电图引导行右锁骨下静脉穿刺导管尖端位置的到位率优于传统置管法,且导管置入深度少于传统法,值得临床推广应用。Objective To assess the targeting rate and adverse events of right-artrial ECG （ RAECG） guided versus conven-tional subclavicular vein tube palcement techniques （ CT） . Methods 40 orthopedics participants under general anesthesia were ran-domly divided into two groups by a random number table. Group A （ n=20 ） got RAECT guided subclavicular vein catheter and Group B （n=20） got CT. The direction of the tube, loaction of the tip of the tube, average catheter depth and ectopia of the tube were recorded by C-arm or chest pain film immediately after the acupuncture. Results Group A had 18 participants with the tip of the tube in superior vena cava and 2 in right internal jugular vein, the accuracy of tube location was 90%;in Group B, 14 partici-pants had the tip of the tube in superior vena cava, 6 in right internal jugular vein, the accuracy was 70%, there was significant dif-ferece between the two groups （P＆lt;0. 05）. The depth of catheter in Group A was （11. 3±1. 2）cm, and （14. 45± 1. 6）cm in Group B, with statistical significance between the two groups （P〈0. 05）; and there was no difference between the acupuncture time and adverse events （acupucture into arteries, rate of pneumothorax） in two groups （P 〈0. 05）. Conclusion The targeting rate of RAECG was better than CT, and the depth of the tube was smaller in RAECG group. So RAECG is a good techique and should be spread in clincal works.

关 键 词：右心房心电图 锁骨下静脉 中心静脉置管术 

分 类 号：R614[医药卫生—麻醉学]