急诊床旁超声引导下中心静脉置管可行性研究  

A study on feasibility of emergency bedside ultrasound-guided central venous catheterization

作　　者：李铁刚[1] 王娜娜[1] 赵敏[1] 

机构地区：[1]中国医科大学附属盛京医院急诊科,辽宁沈阳110004

出　　处：《中华危重病急救医学》2015年第9期724-728,共5页Chinese Critical Care Medicine

基　　金：国家自然科学基金（81301627）;辽宁省博士启动基金资助项目（20131146）

摘　　要：目的评估急诊科医生对危重患者独立进行床旁超声引导下中心静脉置管的可行性和临床意义。方法回顾性分析2009年1月至2014年6月中国医科大学附属盛京医院急诊科216例需行中心静脉置管患者的临床资料，所有患者均采用股静脉穿刺或颈内静脉穿刺置管术。根据置管方式将患者分为3组，急诊科医生独立进行床旁超声引导下中心静脉置管的72例患者纳入A组；由超声科医生辅助超声定位后再由急诊科医生进行中心静脉置管的72例患者纳入B组；采用传统体表标志定位法进行中心静脉置管的72例患者纳入C组。比较3组患者的置管成功率、置管时间、穿刺次数以及并发症发生率。结果急诊科医生独立完成床旁超声引导下中心静脉导管的总成功率较超声定位和传统体表标志定位法明显升高[98．61％（71／72）比83．33％（60／72）、73．61％（53／72），均P〈0．01]，置管时间明显缩短（min：5．5±2．5比9．6±3．7、16．6±7．2，均P〈0．05），穿刺次数减少（次：1．0±0．0比1．8±0．7、2．7±2．6，均P〈0．05），穿刺失败需更换位置发生率明显减少[1．4％（1／72）比8．3％（6／72）、20．8％（15／72），均P〈0．05]，机械性损伤及感染并发症总发生率显著降低[15．3％（11／72）比41．7％（30／72）、59．7％（43／72），均P〈0．05]，同时也未增加导管相关性感染的风险[13．9％（10／72）比15．3％（11／72）、12．5％（9／72），均P〉0．05]。结论急诊科医生独立完成床旁超声引导下中心静脉置管可以提高置管成功率，减少置管相关并发症；该方法可广泛应用于急诊科危重患者的抢救，在指导临床治疗决策方面具有广泛的应用前景。Objective To evaluate the feasibility and clinical significance of emergency bedside ultrasoundguided central venous catheterization performed by emergency department doctors. Methods The clinical data of 216 patients, who underwent central venous catheterization in the Department of Emergency of Shengjing Hospital of China Medical University from January 2009 to June 2014 were retrospectively analyzed. All the patients received femoral vein puncture or internal jugular vein catheterization. The patients were divided into three groups according to the method of catheterization： 72 patients received emergency ultrasound-guided central venous catheterization by emergency doctors independently were assigned as A group, 72 patients underwent catheterization by emergency doctors after being demarcated by ultrasound doctors served as B group, and 72 patients who underwent catheterization method guided by traditional landmark served as C group. Success rate, time spent for catheterization, number of attempts for intubation, and incidence of complications were compared among three groups. Results As compared with that of groups B and C, a higher success rate [98.61% （71/72） vs. 83.33% （60/72）, 73.61% （53/72）, both P 〈 O.O1 ] was found in group A, also with a shorter successful time for insertion of the catheter （minutes： 5.5± 2.5 vs. 9.6 ± 3.7, 16.6 ± 7.2, both P 〈 0.05 ）, less frequency of the catheter insertion （times： 1.0 ±0.0 vs. 1.8±0.7, 2.7 ± 2.6, both P 〈 0.05）, and lower incidence of changing puncture site due to insert failure [ 1.4% （1/72） vs. 8.3% （6/72）, 20.8% （15/72）, bothP 〈 0.05 ], lower incidence of mechanical and infective complication [ 15.3% （11/72 ） vs. 41.7% （30/72）, 59.7% （43/72）, both P 〈 0.05], and also lower catheterization related infection risk [ 13.9% （10/72） vs. 15.3% （11/72）, 12.5% （9/72）, both P 〉 0.05 ]. Conclusion Emergency bedside ultrasound-guided catheterization resulted in higher success rate and less rela

关 键 词：急诊 床旁超声 中心静脉置管 

分 类 号：R445.1[医药卫生—影像医学与核医学] R459.7[医药卫生—诊断学]