不同超声引导方式在ICU患者颈内静脉穿刺置管中临床比较  

Comparison of different ultrasound-guided mode for internal jugular vein catheterization in ICU patients

作　　者：刘伟[1] 孙晓旭[1] LIU Wei;SUN Xiao-xu(Department of Intensive Medicine,Shenyang Fifth People＇s Hospitd,Shenyang 110023,Liaoning,China)

机构地区：[1]沈阳市第五人民医院重症医学科,辽宁沈阳110023

出　　处：《生物医学工程与临床》2018年第4期423-425,共3页Biomedical Engineering and Clinical Medicine

摘　　要：目的比较两种不同超声引导方式下进行颈内静脉穿刺置管术的优劣。方法选择2016年12月至2017年12月沈阳市第五人民医院重症监护病房(ICU)收治的危重患者92例,其中男性58例,女性34例;年龄19~93岁。均无颈内静脉穿刺禁忌证。随机分为静态引导组及动态引导组,每组46例[静态引导组男性27例,女性19例,年龄(59.2±16.3)岁;动态引导组男性31例,女性15例,年龄(61.3±14.9)岁]。分别采用超声定位及实时引导进行穿刺。比较两组的首次穿刺成功率、总成功率、穿刺时间及并发症发生情况。结果静态引导组穿刺时间[(7.6±2.7)min]短于动态引导组穿刺时间[(13.6±2.1)min](t=2.435,P<0.05)。静态引导组首次穿刺成功率为84.8%,总成功率91.3%;动态引导组首次穿刺成功率89.1%,总成功率95.7%。两组比较,差异无统计学意义(χ~2=1.278,P>0.05)。静态引导组误穿动脉3例,血肿3例,并发症发生率13.0%;动态引导组误穿动脉1例,血肿1例,并发症发生率4.3%;差异有统计学意义(P<0.05)。结论两种超声引导方式同样有效,又各有优势。临床工作中可根据患者病情和治疗需要合理选择。Objective To compare the advantages and disadvantages of different ultrasound-guided mode in internal jugular venous catheterization. Methods From December 2016 to December 2017, 92 critical illness patients with internal jugular vein catheterization were enrolled, which included 58 males and 34 females, aged 19-93 years old, none of them had contraindications to internal jugular vein puncture. All patients were randomly divided into static ultrasound-guided group[（n = 46,27 males and 19 females, aged（59.2 ± 16.3） years old,using ultrasound positioning puncture] and dynamic ultrasound-guided group[（n = 46, 31 males and 15 females, aged（61.3 ± 14.9） years old, using real-time guidance puncture]. The first puncture success rate, total success rate, puncture time and complications were compared between 2 groups. Results The operation time of static ultrasound-guided group[（7.6 ± 2.7） minutes] was significantly shorter than that of dynamic ultrasoundguided group[（13.6 ± 2.1） minutes]（t = 2.435, P〈0.05）. The success rate of the first puncture in static ultrasound-guided group was 84.8 %, and total success rate was 91.3 %, and in dynamic ultrasound-guided group was 89.1 % and 95.7 %, respectively. There was no significant difference between 2 groups（χ2= 1.278, P〉0.05）. In static ultrasound-guided group, 3 cases were mistaken for arterial failure, 3 of hematoma, the incidence of complications was 13.0 %. In dynamic ultrasound-guided group, 1 case of arterial puncture and 1 of hematoma, the incidence of complications was 4.3 %; the rate of complications was statistically significant in 2 groups（P〈0.05）. Conclusion It is demonstrated that the two different ultrasound-guided mode showed same effect with its own advantages, so the reasonable selection is needed according to patient condition and treatment in clinic.

关 键 词：静态超声引导 动态超声引导 颈内静脉穿刺置管 重症监护 

分 类 号：R445.1[医药卫生—影像医学与核医学] R654.3[医药卫生—诊断学]