不同解剖定位方法引导锁骨下静脉穿刺的精准性研究  

Study on accuracy of different anatomical landmarks guided subclavian vein puncture

作　　者：谭梦姣 刘功俭 王然 孙维维 TAN Meng-jiao;LIU Gong-jian;WANG Ran;SUN Wei-wei(Department of Anesthesiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou Jiangsu 221000,China;School of Anesthesiology,Xuzhou Medical University,Xuzhou Jiangsu 221000,China)

机构地区：[1]徐州医科大学附属医院麻醉科,江苏徐州221000 [2]徐州医科大学麻醉学院,江苏徐州221000

出　　处：《局解手术学杂志》2019年第10期807-810,共4页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的使用Mimics软件模拟锁骨下静脉(SCV)穿刺,对比不同解剖定位方式引导SCV穿刺的精准性,分析穿刺失败的原因。方法收集徐州医科大学附属医院2013年6月至2018年5月收治的行颈胸部CT的患者175例,使用Mimics软件重建胸部三维解剖模型,每例均按不同解剖定位方法模拟SCV穿刺:锁骨中外1/3法(L组,n=175)、锁骨中内1/3法(I组,n=175)、锁骨中点法(M组,n=175)。记录模拟穿刺结果,测量锁骨下静脉位置参数,分析失败原因。结果 M组的模拟穿刺成功率高于I组和L组,差异有统计学意义(P <0. 05);I组和L组之间模拟穿刺成功率差异无统计学意义(P> 0. 05)。M组有17例模拟穿刺失败,且模拟穿刺针均位于SCV上方。I组39例模拟穿刺失败,其中20例模拟穿刺针高于SCV,19例低于SCV。L组30例模拟穿刺失败,其中24例模拟穿刺针高于SCV,6例低于SCV。结论进行锁骨下静脉穿刺时,选择锁骨中点法进针穿刺成功率更高。Objective To compare the accuracy of different anatomical landmarks for subclavian vein ( SCV) puncture guidance by simulating SCV puncture with Mimics software,and to analyze the reason for puncture failure. Methods A total of 175 patients of cervical and thoracic CT who were admitted into the affiliated hospital of Xuzhou medical university from June 2013 to May 2018 were collected. After 3D reconstructing the cervical and thoracic anatomical model with Mimics,SCV puncture was simulated by three different landmark guiding methods. For group L ( n =175),the outer 1/3 point of clavicle was regarded as the landmark. For group I ( n =175),the inner 1/3 point of clavicle was regarded as the landmark. For group M ( n =175),the middle point of clavicle was regarded as the landmark. Recorded the simulated puncture results,measured the position parameters of subclavian vein,and analyzed the reasons for failure. Results The rate of successful puncture in group M was higher than that in group I and group L ( P < 0. 05),and there was no significant difference between group I and group L ( P >0. 05). A total of 17 cases in the group M were not successfully punctured,and the puncture needles were all loca- ted above the SCV. In group I,39 patients were not successfully punctured,and 20 cases of the puncture needles were located above the SCV while the other 19 cases were located below the SCV. A total of 30 patients in group L were not punctured successfully. Among them, 24 needles were placed above SCV and 6 needles were placed below the SCV. Conclusion When performing SCV puncture,regarding the middle point of clavicle as the anatomical landmark is better for higher rate of successful puncture.

关 键 词：锁骨下静脉穿刺置管 计算机辅助设计 解剖定位 模拟穿刺 三维重建 

分 类 号：R323.2[医药卫生—人体解剖和组织胚胎学]