穿刺针预装载导丝技术在小儿超声引导下头臂静脉导管插入术中的应用  

Application of needle preloaded with guide-wire technology in pediatric ultrasound-guided brachiocephalic vein catheterization

作　　者：贾海涛 刘鹏[2] 马翔宇 张伟[1,2] 何云清 周佼佼 王文晖 周文宇 黄生辉[1,2] Jia Haitao;Liu Peng;Ma Xiangyu;Zhang Wei;He Yunqing;Zhou Jiaojiao;Wang Wenhui;Zhou Wenyu;Huang Shenghui(Department of Anesthesiology,The Second Hospital of Lanzhou University,Lanzhou 730030,China;The Second Clinical Medical School,Lanzhou University,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院麻醉手术科,甘肃兰州730030 [2]兰州大学第二临床医学院,甘肃兰州730030

出　　处：《兰州大学学报（医学版）》2024年第9期40-46,共7页Journal of Lanzhou University（Medical Sciences）

基　　金：兰州大学第二医院“萃英学子科研培育”计划资助项目(CYXZ2022-52)。

摘　　要：目的评估穿刺针预装载导丝技术在小儿患者锁骨上路径超声引导头臂静脉(BCV)中心静脉导管插入术(CVC)中的有效性和安全性。方法穿刺前将穿刺针和装有导丝的塑料鞘相连,并将导丝推进至穿刺针的尖端。超声探头置于锁骨上窝,使用长轴平面内引导技术由探头的外侧向内侧进行BCV穿刺和导丝置入。评估左右侧BCV血管穿刺、导丝置入、导管放置成功率及并发症。结果共纳入60例患儿,平均年龄135 d(4~330 d),平均体重5.8 kg(2.8~8.9 kg)。所有患儿均在3次内成功完成BCV穿刺,首次穿刺成功率为70%。导丝置入次数均≤3次,首次导丝置入成功率为92%。导管置入次数均≤2次,首次导管置入成功率为92%。CVC成功率为100%。4例(7%)患儿在BCV穿刺过程中出现皮下血肿。血管穿刺、导丝置入、导管放置成功率在左侧和右侧BCV间无统计学意义(P>0.05)。结论穿刺针预装载导丝技术可安全有效地用于小儿患者锁骨上路径超声引导BCV穿刺置管术。左侧或右侧BCV的选择可基于临床环境和操作者的经验。Objective To evaluate the efficacy and safety of needle preloaded with a guide-wire for ultrasoundguided catheterization of brachiocephalic vein(BCV)in pediatric patients.Methods The needle was attached to the plastic cover of the guide-wire prior to skin puncture,and the guide-wire was then advanced near the tip of the needle.The probe was placed in the supraclavicular fossa,and then BCV puncture and guide-wire advancement was strictly under the long axis in-plane ultrasound-guided from lateral to medial of the probe.Success rates of vascular puncture,guide-wire and catheter placement,as well as immediate complications,were assessed.Results A total of 60 infant patients were included in this prospective observational study.The mean±standard deviation(SD)of age and weight was 135 days(range 4~330 days)and 5.8 kg(2.8~8.9 kg),respectively.All puncture attempts were≤3;the success rate on the first attempt was 70%.The guide-wire attempts were also≤3;the successful insertion on the first attempt was 92%.The catheter placement attempts were≤2;the successful placement on the first attempt was 92%and the overall success rate of CVC was 100%.Four patients(7%)had subcutaneous hematoma during venipuncture.There were no significant differences between left and right BCV in the success rates of vascular puncture,guide-wire and catheter placement(P>0.05).Conclusion The needle preloaded with a guide-wire can be used safely and effectively in supraclavicular ultrasound-guided BCV catheterization in pediatric patients.The choice of left or right BCV may depend on each clinical context and operator experience.

关 键 词：超声引导 穿刺针 导丝 头臂静脉 小儿 中心静脉导管插入术 

分 类 号：R615[医药卫生—外科学]