颈内静脉和锁骨下静脉穿刺入路的解剖学特点及临床应用  

Anatomic features and clinical application of the internal jugular vein and subclavian vein puncture

作　　者：张强华[1] 周钢[2] 张国艳[3] 

机构地区：[1]佳木斯大学附属第一医院麻醉科,黑龙江佳木斯154002 [2]佳木斯大学附属第一医院心胸外科,黑龙江佳木斯154002 [3]佳木斯大学附属第一医院肾内科,黑龙江佳木斯154002

出　　处：《局解手术学杂志》2017年第1期48-51,共4页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的解剖学比较颈内静脉和锁骨下静脉2种穿刺入路的优缺点,探讨临床建立中心静脉通路的最佳方法。方法选择2014年1月至2016年1月佳木斯大学附属第一医院开胸手术患者120例,根据静脉穿刺入路的不同将患者分为颈内静脉组和锁骨下静脉组,每组60例,穿刺操作由同一组医师进行。评价2种穿刺的学习曲线例数、一次穿刺成功率、完成时间和并发症发生率等指标。结果颈内静脉组穿刺操作完成时间为(22.00±5.58)min,一次穿刺成功率52%,学习曲线例数12例,锁骨下静脉穿刺组则分别为(11.60±2.67)min,93%和3例,2组比较有统计学差异(P<0.05);颈内静脉组总的穿刺并发症发生率为58%,而锁骨下静脉组为12%,2组比较差异有统计学意义(P<0.05)。结论经锁骨下入路锁骨下静脉穿刺操作的难易度、安全性和穿刺并发症发生率均优于颈内静脉穿刺,抢救休克等危重患者需要建立中心静脉通路时首选锁骨下入路锁骨下静脉穿刺。Objective To compare the advantages and disadvantages of internal jugular vein and subclavian vein puncture approach by clinical and anatomical ways so as to explore the best way of establishing a central venous access to guide clinical work. Methods The 120 patients who were admitted into our hospital from January 2014 to January 2016 were randomly divided into the internal jugular vein group and the subclavian vein group with 60 cases in each group according to puncture approach, and the puncture were operated by the same group of physicians. The learning curve, puncture success rate, completion time, complication rates and other indicators of the two groups were evalua- ted. Results The operating completion time of internal jugular vein puncture group was （ 22.0（3 ＋- 5.58） minutes, the success rate was 52% , the learning curve was 12 eases;while the subclavian vein puncture group was （11.60 _＋ 2.67）minutes,93% and 3 cases respectively, and the differences were statistically significant between the two groups（P 〈 0.05 ）. The total complication rate of the internal jugular vein punc- ture group was 58% while the subclavian vein group was 12% , and the difference was statistically significant（ P 〈 0.05 ）. Conclusion Dif- ficulty, safety and complication rates of subclavian vein puncture approach were better than those of the internal jugular vein puncture ap- proach. Therefore, subclavian vein puncture approach should be the first choice when there＇ s a need to establish central venous access for rescuing severe patients such as shock.

关 键 词：颈内静脉 锁骨下静脉 中心静脉穿刺 学习曲线 并发症 

分 类 号：R322.12[医药卫生—人体解剖和组织胚胎学] R472[医药卫生—基础医学]