超声引导下颈外静脉穿刺预置管在侧卧位手术紧急抢救中应用的可行性  

Feasibility of Ultrasonic-Guided External Jugular Venipuncture Preplacement in Emergency Rescue of Lateral Decubitus Surgery

作　　者：蔡东妙[1] 王海振 汪海松[1] 吴冬金[1] 许智鸿 CAI Dongmiao;WANG Haizhen;WANG Haisong;WU DongJin;XU Zhihong(Department of Anesthesia,The First Affiliated Hospital of Xiamen University,Xiamen 361000,China)

机构地区：[1]厦门大学附属第一医院麻醉手术科,厦门361000

出　　处：《中国医药指南》2024年第25期10-13,共4页Guide of China Medicine

摘　　要：目的探讨超声引导下颈外静脉穿刺预置管在侧卧位手术紧急抢救中应用的可行性及临床效果。方法选择60例自2023年10月至2024年1月于本院择期行侧卧位下手术(包括胸腔镜下肺叶切除手术、开放性肺叶切除手术、肾部分切除手术等)预计术中出血风险高的患者,按照随机数字表法均分为两组,每组30例,观察组采用超声引导法行颈外静脉穿刺预置管,对照组采用常规压迫颈外静脉盲穿法预置管。记录并分析两组手术类型、左/右侧卧例数、穿刺次数、一次性穿刺成功率、最终穿刺成功率、穿刺时间、留置导管例数及术中大量出血例数、出血量、补液量以及穿刺并发症的发生情况。结果观察组一次穿刺成功的发生率为高于对照组(93.33%vs.70.00%,χ^(2)=4.007,P=0.045);观察组最终穿刺成功率高于对照组(100%vs.80.00%,χ^(2)=4.630,P=0.031);观察组穿刺次数少于对照组[(1.20±0.48)次vs.(1.57±0.86)次,]、穿刺并发症(血肿发生率)少于对照组(3.33%vs.26.67%)(均P<0.05);观察组穿刺时间长于对照组【(113.20±20.63)s vs.(60.93±24.46)s,t=8.947,P<0.05】;两组留置导管例数、术中大量出血例数、出血量及补液量比较差异无统计学意义(P>0.05)。结论采用超声引导下颈外静脉穿刺预置管可以提高建立静脉通路成功率,减少穿刺次数及穿刺并发症,但需要提高超声应用熟练程度以缩短穿刺时间,临床操作可行性强。Objective To investigate the feasibility and clinical effect of ultrasound-guided external jugular venipuncture preplacement in the emergency rescue of lateral decubitus operation.Methods A total of 60 patients with high risk of intraoperative bleeding who underwent lateral decubitus surgery(including thoracoscopic lobectomy,open lobectomy,partial nephrectomy,etc.)in our hospital from October 2023 to January 2024 were selected and divided into two groups according to random number table method,with 30 patients in each group.The patients in the observation group received ultrasonic-guided preplacement of external jugular vein puncture,while the patients in the control group received conventional compression of external jugular vein blind puncture preplacement.The type of operation,the number of left/right lateral decubitus cases,the number of puncture times,the success rate of one-time puncture,the final success rate of puncture,the puncture time,the number of indwelling catheter,the number of intraoperative massive bleeding cases,the amount of bleeding,the amount of fluid infusion,and the incidence of puncture complications were recorded and analyzed.Results The incidence of successful primary puncture in the observation group was higher than that in the control group(93.33%vs.70.00%,χ^(2)=4.007,P=0.045);the final puncture success rate in the observation group was higher than that in the control group(100%vs.80.00%,χ^(2)=4.630,P=0.031);the number of puncture attempts in the observation group was fewer than that in the control group[(1.20±0.48)times vs.(1.57±0.86)times]and puncture complications(hematoma incidence)were less than those in the control group(3.33%vs.26.67%)(both P<0.05);the puncture time in the observation group was longer than that in the control group[(113.20±20.63)s vs.(60.93±24.46)s,t=8.947,P<0.05];the number of cases of catheterization,cases of massive bleeding,and amount of bleeding in the two groups was lower than that in the control group.There was no statistically significant differenc

关 键 词：侧卧位手术 静脉穿刺 超声 静脉通路 抢救 

分 类 号：R641[医药卫生—外科学]