肩部体位对锁骨下入路穿刺静脉导管尖端位置的影响  

Influence of shoulder position on central venous catheter tip location during infraclavicular subclavian approach

作　　者：张凌杰[1] 裴皓[1] 

机构地区：[1]湖北省新华医院麻醉科,武汉430015

出　　处：《中华实验外科杂志》2014年第11期2585-2586,共2页Chinese Journal of Experimental Surgery

摘　　要：目的 比较中位肩和低位肩对导管尖端位置变化的影响.方法 359例被分为2组：组Ⅰ（低位肩）180例,组C（中位肩）179例.全身麻醉诱导气管插管后患者右肩位置根据分组不同而调整,右锁骨下静脉穿刺置管.手术后拍X线胸部平片,检查是否有气胸并记录导管尖端的位置.结果 Ⅰ组导管尖端位置异常总发生率[14例（7.8％）]明显高于C组[2例（1.1％）,P＜0.01],其中Ⅰ组置入同侧颈内静脉发生率和置入对侧头臂静脉发生率[8例（4.4％）,6例（3.3％）]明显高于C组[2例（1.1％）,0例,P＜0.01].结论 锁骨下静脉穿刺时中性肩体部可减少导管错位率.Objective Comparing the influence of neutral shoulder and lowered shoulder on central venous catheter tip location during infraclavicular cubclavian approach.Methods 359 patients who required subclavian central venous catheterization were randomly divided into two groups：neutral （n =179） and lowered （n =180） shoulder position.In Group C,the right shoulder was kept in the neutral position during venipuncture and guide-wire insertion.Postoperative chest radiographs were obtained to identify the location of catheter tips.Results Aberrant placement of the catheter tips in group Ⅰ [14 （7.8%）] was more frequent than that in group C [2 （1.1%）] （P 〈 0.01）,and then the incidence of misplaced catheter tips in either the ipsilateral internal jugular vein or the contralateral brachiocephalic vein in group Ⅰ [8 （4.4%）,6 （3.3%）] was significantly higher than that in group C [2 （1.1%）,0,P〈0.01].Conclusion The neutral shoulder position minimizes the number of needle passes and the incidence of catheter misplacement during the infraclavicular approach of the right subclavian vein catheterization.

关 键 词：锁骨下静脉 锁骨下入路 导管尖端错位 

分 类 号：R472[医药卫生—护理学]