实时超声引导成人颈内静脉穿刺置管的应用价值  

The role of real-time two-dimensional ultrasound guidance for internal jugular vein cannulation

作　　者：肖扬[1] 李伟彦[2] 陈丽芬[1] 胡陈鳞[1] 

机构地区：[1]解放军第一一八医院麻醉科,浙江省温州市325000 [2]南京军区南京总医院麻醉科

出　　处：《临床超声医学杂志》2015年第1期57-59,共3页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨实时超声引导在成人颈内静脉穿刺置管中的辅助作用,以评价其临床价值。方法 180例需行颈内静脉穿刺置管的患者分为A、B两组(A组:按解剖部位行常规颈内静脉穿刺置管者100例;B组:实时超声引导下行颈内静脉穿刺置管者80例)。操作前简单评估穿刺难度及可能出现的并发症,分别记录准备时间、操作时间、穿刺次数、成功率及并发症等。结果 A、B组穿刺前评估颈内静脉穿刺置管困难者分别为15例和32例。A组89例置管成功(89%),B组80例均置管成功(100%),差异有统计学意义(P<0.05)。B组穿刺困难者穿刺时间[(10.7±4.6)s]较A组明显缩短[(450.7±233.8)s],差异有统计学意义(P<0.05)。A组穿刺困难者一次穿刺成功4例,穿刺总成功率为60%,B组穿刺困难者一次穿刺成功27例,穿刺总成功率为100%。A、B组发生误伤动脉、臂丛、血肿及气胸的几率分别为10.0%、2.0%、4.0%、1.0%和2.0%、1.0%、1.0%、0。结论实时超声引导可提高成人颈内静脉穿刺的成功率和安全性,尤其是穿刺置管困难的患者。Objective To evaluate the role of real-time two-dimensional ultrasound guidance for internal jugular vein cannulation. Methods Totally 180 patients were divided into two groups, including group A（100 patients underwent conventional internal jugular vein cannulation） and group B（80 patients underwent internal jugular venous cannulation under ultrasound-guidence）. Before the operation,the difficulty of cannulation and possible complications were simply evaluated. During the operation,the prepared time,access time,number of attempts,success rate,one-attempt success rate and procedural complications were recorded. Results Fifteen cases were assessed to be difficult for cannulation of the internal jugular vein in group A and32 cases in group B. Cannulation of the internal jugular vein was achieved in 89 patients（89%）in group A,and in all patients（100%）in group B,there was significant difference（P〈0.05）. The average access time in group B[（10.7±4.6）s]was shorter than that in group A[（450.7±233.8）s],there was significant difference（P〈0.05）. Four patients with difficult cannulation in group A were one-attempt success,the total success rate was 60%,while 27 patients with difficult cannulation in group B were one-attempt success,the total success rate was 100%. The occurence rates of accidently injure in artery and brachia plexus, pneumothorax and hematoma in group A and group B were 10.0%,2.0%,4.0%,1.0% and 2.0%,1.0%,1.0%,0. Conclusion Real-time two-dimensional ultrasound can significantly improve the success rate and safety of internal jugular vein cannulation.

关 键 词：超声检查 实时 颈内静脉 成人 置管 

分 类 号：R445.1[医药卫生—影像医学与核医学]