超声引导锁骨上入路锁骨下静脉穿刺在颅脑手术中的应用效果  

Application of ultrasound-guided subclavian vein puncture via supraclavicular approach in craniocerebral surgery

作　　者：杨犇[1] 程志坤[1] 马启刚[1] 李娟[2] 武百山[3] YANG Ben;CHENG Zhi-kun;MA Qi-gang;LI Juan;WU Bai-shan(Department of Anesthesiology,Lu’an Hospital of Traditional Chinese Medicine,Lu’an Anhui 237000,China;Department of Anesthesiology,First Affiliated Hospital of University of Science and Technology of China,Hefei Anhui 230001,China;Department of Pain Treatment,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]六安市中医院麻醉科,安徽六安237000 [2]中国科学技术大学附属第一医院麻醉科,安徽合肥230001 [3]首都医科大学宣武医院疼痛科,北京100053

出　　处：《局解手术学杂志》2022年第4期328-332,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：安徽省自然科学基金(1908085MH251)。

摘　　要：目的探讨超声引导锁骨上入路锁骨下静脉(SCV)穿刺在颅脑手术中的应用效果。方法选择80例需要中心静脉置管的颅脑手术患者,随机分为锁骨下入路组(n=40)和锁骨上入路组(n=40)。记录2组SCV长轴图像超声定位时间;测量2组SCV长轴图像与探头的垂直距离;测量2组SCV的平均内径;记录2组穿刺时间、总穿刺次数、一次穿刺成功率、总穿刺成功率;记录2组误穿动脉、气胸等并发症的发生情况。结果与锁骨下入路组相比,锁骨上入路组SCV长轴图像超声定位时间更短(P<0.05),SCV长轴图像与探头的垂直距离更短(P<0.05),SCV的平均内径明显较长(P<0.05),穿刺时间明显较短(P<0.05),总穿刺次数明显较少(P<0.05),一次穿刺成功率明显较高(P<0.05)。2组总穿刺成功率及并发症发生率比较差异无统计学意义(P>0.05)。结论超声引导锁骨上入路SCV穿刺具有定位时间短、穿刺时间短、穿刺成功率高等优势,值得在颅脑手术中推广应用。Objective To investigate the application of ultrasound-guided subclavian vein(SCV)puncture via supraclavicular approach in craniocerebral surgery.Methods A total of 80 patients undergoing craniocerebral surgery who needed central venous catheter were selected andrandomly divided into the subclavian approach group(n=40)and the supraclavicular approach group(n=40).The ultrasonic localization time of long axis image of SCV in the two groups were recorded.The vertical distance between the long axis image of SCV and the probe in the two groups were measured.The average inner diameter of SCV in the two groups were measured.The puncture time,total number of puncture,success rate of one puncture and total success rate of puncture in the two groups were recorded.The complications such as accidental puncture of artery and pneumothorax in the two groups were recorded.Results Compared with the subclavian approach group,the ultrasonic localization time of long axis image of SCV was shorter in the supraclavicular approach group(P<0.05),the vertical distance between the long axis image of SCV and the probe was shorter(P<0.05),the average inner diameter of SCV was significantly longer(P<0.05),the puncture time was significantly shorter(P<0.05),the total number of puncture was significantly less(P<0.05),the success rate of one puncture was significantly higher(P<0.05).There was no significant difference in the total success rate of puncture and complication rate between the two groups(P>0.05).Conclusion Ultrasound-guided subclavian vein puncture via supraclavicular approach has the advantages of short localization time,short puncture time and high success rate of puncture,which is worthy of popularization and application in craniocerebral surgery.

关 键 词：超声引导 锁骨下静脉 锁骨上入路 穿刺术 颅脑 手术 

分 类 号：R472[医药卫生—护理学]