改良性儿童右锁骨下静脉穿刺置管术对减少导管异位的影响  

Effect of modified right subclavian vein catheterization in children on reducing catheter malposition

作　　者：王雪青 陈媛珍 胥亮 徐波 WANG Xue-qing;CHEN Yuan-zhen;XU Liang;XU Bo(Department of Anesthesiology,Shenzhen Children′s Hospital,Shenzhen 518000,Guangdong,China)

机构地区：[1]深圳市儿童医院麻醉科,广东深圳518000 [2]南部战区总医院麻醉科,广东广州510010

出　　处：《广东医学》2024年第10期1266-1271,共6页Guangdong Medical Journal

基　　金：国家自然科学基金项目(62076253)。

摘　　要：目的探讨体位和置管时导丝部分回撤对减少导管异位的有效性和安全性。方法选需行右侧锁骨下静脉穿刺置管的患儿随机分为两组:观察组(A组82例)和对照组(B组82例)。A组采用平卧位,置管时导丝部分回撤。B组采用传统的置管方法,即采用头低脚高位,置管时导丝全程引导导管置入。术中超声检查导管尖端方向。结果3例患者(A组2例,B组1例)反复穿刺血管失败,改为右颈内静脉置管。第一次置管导管尖端方向的正确率R1,A组高于B组(P<0.05);第一次置管导管尖端异位在右侧颈内静脉的异位率R2,A组低于B组(P<0.05),两组R1、R2差异有统计学意义;两组第一次置管导管尖端异位在左头臂静脉(左锁骨下静脉)的异位率R3、并发症和一般资料比较差异无统计学意义(P>0.05)。结论平卧位导丝部分回撤导管置入法可以提高儿童右侧锁骨下静脉穿刺置管术导管尖端方向的正确率、且该方法是安全的。Objective To explore the effectiveness and safety of adjusting patient position and partial withdrawal of the guidewire during catheter placement in reducing catheter malposition.Methods Children undergoing right subclavian vein catheterization were randomly divided into two groups:the experimental group(Group A,82 cases)and the control group(Group B,82 cases).In Group A,the patients were in the supine position,and the guidewire was partially withdrawn during catheter insertion.In Group B,the traditional method was used,with the patient in a head-down,foot-up position,and the guidewire fully guiding the catheter.Ultrasound was used intraoperatively to assess the catheter tip direction.Results Three patients(2 from Group A and 1 from Group B)required multiple attempts at vascular puncture and were switched to right internal jugular vein catheterization.The accuracy of the catheter tip direction on the first attempt(R1)was higher in Group A than in Group B(P<0.05).The incidence of catheter malposition into the right internal jugular vein on the first attempt(R2)was lower in Group A than in Group B(P<0.05),with statistically significant differences between the two groups in R1 and R2.There was no significant difference between the two groups in the incidence of malposition into the left brachiocephalic vein(left subclavian vein)(R3),complications,or general clinical data(P>0.05).Conclusion The supine position with partial withdrawal of the guidewire during catheter insertion improves the accuracy of catheter tip placement in right subclavian vein catheterization in children and is a safe method.

关 键 词：儿童 右锁骨下静脉 导管尖端 

分 类 号：R614[医药卫生—麻醉学] R615[医药卫生—外科学]