床旁超声引导下中心静脉置管在危重患儿治疗中的应用  

Application of bedside ultrasound-guided central venous catheterization in critically ill children

作　　者：崔利丹[1] 金志鹏[1] 王琪[1] 成怡冰[1] 王群思[1] 

机构地区：[1]郑州市儿童医院儿童重症监护病房,河南郑州450018

出　　处：《新乡医学院学报》2017年第3期241-244,共4页Journal of Xinxiang Medical University

摘　　要：目的评估床旁超声引导下中心静脉置管在儿童重症监护病房(PICU)危重患儿中应用的可行性和临床意义。方法收集2013年1月至2015年12月郑州市儿童医院PICU入住的168例需行中心静脉置管患儿的临床资料,所有患儿均采用颈内静脉穿刺或股静脉穿刺置管术。根据置管方式将患儿分为观察组(86例)和对照组(82例),观察组患者在PICU医生独立进行床旁超声引导下中心静脉置管;对照组患者采用体表标志定位法进行中心静脉置管。比较2组患儿的置管成功率、穿刺置管时间、穿刺次数以及穿刺并发症发生率。结果观察组患儿在超声引导下中心静脉置管的总成功率为97.67%(84/86),显著高于对照组患儿的70.73%(58/82)(χ2=4.26,P<0.05),其中颈内静脉穿刺置管成功率观察组患儿为97.50%(78/80),显著高于对照组患儿的70.67%(53/75)(χ2=3.96,P<0.05),股静脉置管成功率观察组患儿为100.00%(6/6),对照组患儿为71.43%(5/7),但因股静脉穿刺例数少,2组患儿股静脉置管成功率比较差异无统计学意义(χ2=2.58,P>0.05)。观察组患儿平均穿刺次数为1.25±0.73,显著少于对照组的2.85±2.05(t=2.74,P<0.05);观察组患儿平均置管时间(7.16±2.68)min,显著短于对照组的(16.31±5.47)min(t=2.39,P<0.05)。观察组患儿发生机械性损伤3例(误穿动脉1例、血肿2例),感染8例,并发症发生率为12.79%(11/86);对照组患儿发生机械性损伤28例(误穿动脉17例、血肿11例),感染6例,并发症发生率为41.46%(34/82);对照组患儿并发症发生率显著高于观察组(χ2=4.32,P<0.05)。结论床旁超声引导下中心静脉置管可提高置管成功率,减少穿刺次数,缩短置管时间,降低置管相关并发症,可广泛应用于PICU患儿的抢救和治疗。Objective To evaluate the feasibility and clinical significance of application of bedside ultrasound-guided central venous catheterization in critically ill children in pediatric intensive care unit（ PICU）. Methods The clinical data of168 patients who underwent central venous catheterization in Children＇s Hospital of Zhengzhou from January 2013 to December2015 were analyze retrospectively. All of the patients received internal jugular vein puncture or femoral vein catheterization. The patients were divided into two groups according to the method of catheterization. Eighty-six patients were given ultrasoundguided central venous catheterization（ observation group）; eighty-two patients were given central venous catheterization guided by traditional landmark（ control group）. Success rate of catheterization,the time for catheterization,the number of intubation,and incidence of complications were compared between the two groups. Results The overall success rate of bedside ultrasound-guided central venous catheterization of children in the observation group was 97. 67%（ 84 /86）,which was significantly higher than that in the control group 70. 73%（ 58 /82）（ χ2= 4. 26,P 〈 0. 05）. The success rate of internal jugular vein catheterization in observation group（ 97. 50%,78 /80） was significantly higher than that in the control group（ 70. 67%,53 /75）（ χ2= 3. 96,P 〈 0. 05）; the success rate of femoral vein catheterization in the observation group and control group was100. 00%（ 6 /6）,71. 43%（ 5 /7） respectively,there was no statistic difference of the success rate of femoral vein catheterization between the two groups（ χ2= 2. 58,P 〉 0. 05）. The average number of puncture in observation group（ 1. 25 ± 0. 73） was significantly less than that in the control group（ 2. 85 ± 2. 05）（ t = 2. 74,P 〈 0. 05）. The average time of catheterization in observation group and control group was（ 7. 16 ± 2. 68）,（ 16. 31 ± 5. 47） min respectively; the average time o

关 键 词：儿童重症监护病房 危重患儿 床旁超声 中心静脉置管 

分 类 号：R472[医药卫生—护理学] R445.1[医药卫生—临床医学]