Nickalls体表定位法腋静脉中心静脉置管在多发伤患者中的应用效果  

Application of axillary vein puncture and catheterization based on Nickalls' landmarks in treating patients with multiple injuries

作　　者：龚嵩 庄杨帆 陈继革[1] 白祥军[1] 李占飞[1] 高伟[1] Gong Song;Zhuang Yangfan;Chen Jige;Bai Xiangjun;Li Zhanfei;Gao Wei(Trauma Center/Department of Emergency and Trauma Surgery, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China)

机构地区：[1]华中科技大学同济医学院附属同济医院创伤中心/急诊创伤外科,武汉430000

出　　处：《中华创伤杂志》2019年第10期918-923,共6页Chinese Journal of Trauma

摘　　要：目的探讨Nickalls体表定位法腋静脉中心静脉置管(CVC)在成人多发伤患者中的应用效果。方法采用回顾性病例对照研究分析2017年8月— 2018年8月华中科技大学同济医学院附属同济医院救治的83例成人多发伤患者临床资料,其中男48例,女35例;年龄21~84岁[(56.5±14.3)岁]。体重指数19.8~43.1 kg/m^2[(27.6±6.5)kg/m^2]。以颅脑损伤为主多发伤26例,以胸部损伤为主多发伤15例,以腹部损伤为主多发伤28例,以脊柱损伤为主多发伤8例,以骨盆骨折为主多发伤6例。损伤严重度评分(ISS)24~66分[(41.8±18.1)分]。患者均接受Nickalls体表定位法腋静脉CVC。16例为左侧组,采用左侧腋静脉作为穿刺静脉;67例为右侧组,采用右侧腋静脉作为穿刺静脉。36例为邻近骨折组,均合并与穿刺部位同侧的锁骨或第1~3肋骨骨折;47例为非邻近骨折组,不合并与穿刺部位同侧的锁骨或第1~3肋骨骨折。统计总体和各组的置管成功率,以及气胸、血肿或动脉损伤、导管异位、导管相关感染和导管相关血栓形成等并发症的发生率。结果共有80例置管成功,总成功率为96%。其中右侧组成功率为97%(65/67),左侧组为94%(15/16)(P>0.05);邻近骨折组成功率为94%(34/36),非邻近骨折组为98%(46/47)(P>0.05)。气胸发生率为2%(2/83),血肿或动脉损伤发生率为5%(4/83),导管相关血栓形成发生率为12%(10/83),导管异位发生率为1%(1/83),未观察到导管相关感染。其中左侧组和右侧组的各种并发症发生率接近(气胸:0∶3%;血肿或动脉损伤:6%∶4%;导管异位:0∶1%;导管相关血栓形成:13%∶12%)(P>0.05);邻近骨折组和非邻近骨折组的各种并发症发生率接近(气胸:3%∶2%;血肿或动脉损伤:3%∶6%;导管异位:0∶2%;导管相关血栓形成:17%∶9%)(P>0.05)。结论Nickalls体表定位法腋静脉CVC在成人多发伤患者中的置管成功率较高,并发症发生率较低,对左、右两侧腋静脉均适用,也适用于合并邻近�Objective To investigate the application of the axillary central venous catheterization (CVC) based on Nickalls' landmarks in treating adult multiple injury patients. Methods A retrospective case control study was conducted to analyze the clinical data of 83 adult multiple injury patients treated in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from August 2017 to August 2018. There were 48 males and 35 females, aged 21-84 years [(56.5±14.3)years]. The body mass index ranged from 19.8 to 43.1 kg/m^2 [(27.6±6.5)kg/m^2]. There were 26 patients with mainly craniocerebral injury, 15 with mainly thoracic injury, 28 with mainly abdominal injury, eight with mainly spinal injury and six with mainly pelvic fracture. The injury severity score (ISS) ranged from 24 to 66 points [(41.8±18.1)points]. All the patients received the axillary CVC based on Nickalls' landmarks. The left axillary vein was used as the puncture vein in 16 patients (left group), and the right axillary vein was used as the puncture vein in 67 patients (right group). A total of 36 patients were combined with the clavicle and/or 1-3 rib fractures at the same side as the puncture site (adjacent fracture group), while 47 patients were not combined with the clavicle and/or 1-3 rib fractures at the same side as the puncture site (non-adjacent fracture group). The success rate of catheterization, pneumothorax, hematoma or artery injury, catheter ectopia, catheter-related infection and catheter-related thrombosis were recorded. Results A total of 80 patients were successfully intubated, with a success rate of 96%. Subgroup analysis showed that the success rate of right group was [97%(65/67)], slightly higher than that of the left group [94%(15/16)], but the difference was not statistically significant (P>0.05). And the success rate of adjacent fracture group [94%(34/36)] was similar to that of non-adjacent fracture group [98%(46/47)], and the difference was not statistically significant (P>0.05). Complic

关 键 词：多处创伤 腋静脉 导管插入术 中心静脉 

分 类 号：R473.6[医药卫生—护理学]