改良解剖定位法在危重症剖宫产颈内静脉穿刺中的应用  

Application of modified anatomic positioning method in internal jugular vein puncture during critical caesarean section

作　　者：王艳双 车向明[1] 徐铭军[1] WANG Yan-shuang;CHE Xiang-ming;XU Ming-jun(Department of Anesthesiology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University/Beijing Maternal and Child Health Care Hospital,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院麻醉科,北京100026

出　　处：《局解手术学杂志》2025年第1期76-79,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：中国妇幼保健协会科研项目(CMCHA-XM-2022-051)。

摘　　要：目的 基于右侧胸锁乳突肌与右颈内静脉的局部解剖关系,探讨改良解剖定位法在危重症剖宫产右颈内静脉穿刺中的应用价值。方法 选取我院产科择期手术的危重症患者360例,所有患者均行右颈内静脉穿刺,按照穿刺入路方法的不同分为观察组(采用改良解剖定位法穿刺)和对照组(采用传统中路法穿刺),每组180例。比较2组患者一次穿刺成功率、总体穿刺成功率、导丝置入失败率的差异,记录2组患者误入动脉、动脉血肿、血气胸、心律失常、臂丛神经损伤等相关并发症的发生率。结果 观察组患者的一次穿刺成功率、总体穿刺成功率明显高于对照组,差异具有统计学意义(P<0.05);观察组患者导丝置入失败率低于对照组,差异有统计学意义(P<0.05)。观察组患者误入动脉、动脉血肿发生率明显低于对照组,差异具有统计学意义(P<0.05);2组患者均无血气胸、心律失常、臂丛神经损伤等并发症发生。结论 与传统中路法穿刺相比,采用改良解剖定位法穿刺具有穿刺成功率高、并发症少、安全性高的优势。Objective Based on the local anatomic relationship between right sternocleidomastoid and right internal jugular vein,the application value of modified anatomic positioning method in right internal jugular vein puncture during critical cesarean section was discussed.Methods A total of 360 critical patients who underwent elective operation in obstetrics department of our hospital were selected,all of whom received right internal jugular vein puncture.According to different puncture approaches,they were divided into the observation group(punctured by modified anatomic positioning method) and the control group(punctured by traditional middle approach method),with 180 cases in each group.The differences in the success rate of one-time puncture,the overall success rate of puncture and the failure rate of guide wire implantation were compared between the two groups.The incidence of complications such as misplacement into the artery,artery hematoma,hemopneumothorax,arrhythmia and brachial plexus injury were compared in the two groups.Results The success rate of onetime puncture and overall success rate of puncture in the observation group were significantly higher than those in the control group,and the differences were statistically significant(P<0.05).The failure rate of guide wire implantation in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).The incidences of misplacement into the artery and artery hematoma in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).No complications such as hemopneumothorax,arrhythmia or brachial plexus injury occurred in the two groups.Conclusion Compared with the traditional middle approach method puncture,the modified anatomic positioning method puncture has the advantages of higher puncture success rate,fewer complications and higher safety.

关 键 词：颈内静脉 危重症剖宫产 局部解剖学 颈内静脉穿刺 成功率 并发症 

分 类 号：R323.2[医药卫生—人体解剖和组织胚胎学] R719.82[医药卫生—基础医学]