不同途径经皮中心静脉置管用于6岁以下小儿的比较  

A comparison of different approaches of percutaneous central venous catheterization in children less than six years of age

作　　者：谭宪湖[1] 谭冠先[1] 赵丽妮[1] 林成新[1] 张炳东[1] 秦科[1] 

机构地区：[1]广西医科大学第一附属医院麻醉科,南宁530021

出　　处：《中华麻醉学杂志》2003年第10期743-745,共3页Chinese Journal of Anesthesiology

基　　金：广西壮族自治区卫生厅立项项目(桂卫Z200029)

摘　　要：目的 通过对锁骨上途径行锁骨下静脉置管与锁骨下途径锁骨下静脉置管及高位前路颈内静脉置管进行比较,评价锁骨上途径锁骨下静脉置管术用于6岁以下小儿的可行性。方法 选择拟施各种大手术6岁以下的小儿180例,随机分为3组,每组60例,Ⅰ组:经锁骨上途径锁骨下静脉穿刺置管;Ⅱ组:经锁骨下途径锁骨下静脉穿刺置管;Ⅲ组:高位前路颈内静脉穿刺置管。观察记录总穿刺成功率、一次试穿成功率、置管成功率、穿刺成功时间、置管完成时间及并发症。Ⅰ组患儿中随机选取30例于术后X线摄胸部平片,观察中心静脉导管位置。结果 Ⅰ组穿刺总成功率为100％,一次穿刺成功率为86.67％,均显著高于Ⅱ组(91.67％和51.67％)和Ⅲ组(93.33％和58.33％)(P<0.05或0.01);Ⅰ组患儿穿刺成功时间(18±5)s,插管完成时间为(134±39)s,均短于Ⅱ组[(65±21 s)和(257±688)]和Ⅲ组[(51±16)s和(184±53)s](P<0.05或0.01)。Ⅱ组误穿动脉2例、置管困难3例;Ⅲ组误穿动脉3例;Ⅰ组无误穿动脉、气胸、血胸及导管异位等并发症发生。结论 经皮锁骨上途径行锁骨下静脉置管用于6岁以下小儿具有操作容易、安全性大、穿刺置管成功率及一次穿刺成功率高等特点,是小儿经皮中心静脉置管有实用价值的方法之一。Objective To evaluate the feasibility of catheterization of subclavian vein via supra-clavicular puncture in children less than six years of age, in comparison with subclavian vein catheterization via infraclavicular puncture and cannulation of internal jugular vein (IJV) from a high medial approach. Methods One hundred and eighty children (104 male, 76 female) aged 15 d-6 yr, undergoing major surgery were randomly divided into 3 equal groups of 60 patients: group I subclavian vein catheterization via supra-clavicular puncture; group Ⅱ subclavian vein catheterization via infra-clavicular puncture and group Ⅲ IJV catheterization from a high medial approach. (1) The overall success rate of puncture, (2) the success rate of puncture at first attempt, (3) the success rate of cannulation, (4) the duration from beginning of puncture to aspiration of blood, (5) the duration from the beginning of puncture to successful cannulation and (6) complication were recorded. Chest X-ray was taken in 30 patients in group I for confirmation of the position of catheter in subclavian vein. Results (1) The overall success rate of puncture was 100% and the success rate of puncture at first attempt was 86.67% in group I significantly higher than those in group Ⅱ (91.96% and 51.67%) and group Ⅲ (93.33% and 58.33%) (P<0.05 or 0.01). (2) The duration of successful puncture and cannulation were (18± 5) s and (134±39) s in group Ⅰ, significantly shorter than those in group Ⅱ[(65±21) s, (257±68) s] and group Ⅲ [(51±16) s, (184±53) s]. (3) No complication occurred in group I including arterial puncture, pneumothorax and hematothorax. In group Ⅱthere were 2 arterial punctures and 1 difficult catheter placement while in group Ⅲarterial puncture occurred in 3 patients. Conclusion Central venous catheterization via supra-clavicular puncture is a reliable and safe technique in children aged < 6yr as compared with the other two techniques.

关 键 词：经皮中心静脉置管 小儿 比较 导管插入术 

分 类 号：R401[医药卫生—临床医学]