手臂位置对超声引导锁骨下静脉穿刺置管的影响  

Influence of arm position on ultrasound-guided subclavian vein in-plane puncture and catheterization

作　　者：邓利兵 蒋晖 葛圣金 DENG Li-bing;JIANG Hui;GE Sheng-jin(Department of Anesthesiology,Qingpu Branch of Zhongshan Hospital,Fudan University,Shanghai 201700,China;Department of Anesthesiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院青浦分院麻醉科,上海201700 [2]复旦大学附属中山医院麻醉科,上海200032

出　　处：《复旦学报（医学版）》2024年第2期225-229,242,共6页Fudan University Journal of Medical Sciences

基　　金：上海市青浦区卫健委青年项目(w2021-04)。

摘　　要：目的探讨手臂位置对超声引导锁骨下静脉平面内穿刺置管的影响。方法选取2021年8—12月在复旦大学附属中山医院青浦分院需行中心静脉穿刺置管的90例全麻手术患者,随机分为外展组(n=45)和内收组(n=45),均在超声实时引导下行锁骨下静脉平面内穿刺置管,观察并记录两组一次穿刺成功率、穿刺总成功率和穿刺并发症情况。结果在超声实时引导锁骨下静脉平面内穿刺置管过程中,外展组一次穿刺成功率为88.9%(40/45),高于内收组的68.9%(31/45),差异有统计学意义(P=0.020);外展组和内收组的总穿刺成功率分别为95.6%(43/45)和82.2%(37/45),差异有统计学意义(P=0.044)。在穿刺并发症方面,内收组有8例穿刺失败,其中2例出现局部血肿,外展组有2例穿刺失败,未发生局部血肿情况,两组均未出现气胸并发症,所有穿刺失败的病例均改行同侧颈内静脉穿刺。结论全麻手术患者中手臂外展90°便于超声实时引导锁骨下静脉平面内穿刺置管,值得临床推广。Objective To investigate the influence of arm position on ultrasound-guided subclavian vein puncture and placement.Methods A total of 90 patients undergoing general anesthesia in Qingpu Branch of Zhongshan Hospital,Fudan University from Aug to Dec 2021 were randomly divided into abduction group(n=45)and adduction group(n=45).The central venous catheter was placed in the plane of subclavian vein under real-time ultrasound guidance.The one-time success rate of puncture,total success rate of puncture and puncture complications of the two groups were observed and recorded.Results In the process of real-time ultrasound-guided subclavian vein puncture,the success rate of onetime puncture in abduction group was 88.9%(40/45),which was significantly higher than that in adduction group(68.9%,31/45),the difference was statistically significant(P=0.020).The total success rate of puncture was 95.6%(43/45)in abduction group and 82.2%(37/45)in adduction group,and the difference was statistically significant(P=0.044).In terms of puncture complications,there were 8 cases of puncture failure in adduction group,including 2 cases of local hematoma,and there were 2 cases of puncture failure in abduction group without local hematoma.No pneumothorax occurred in the two groups,and all the failed cases were replaced by ipsilateral internal jugular vein puncture.Conclusion In patients undergoing general anesthesia,90°arm abduction is convenient for real-time ultrasound-guided subclavian vein puncture and catheterization,which is worthy of clinical promotion.

关 键 词：手臂位置 超声 锁骨下静脉 中心静脉置管 

分 类 号：R614[医药卫生—麻醉学]