胸前区腋静脉穿刺置管的体会.DOCVIP

临床医学论文-胸前区腋静脉穿刺置管的体会 ?????????? 作者：胡小冬，余荣根，李坤，李文辉 [摘 要] 目的 探讨经皮胸前区腋静脉穿刺置管的安全性及临床实用性。方法 自2003年1月至2005年5月对需开放中心静脉患者随机选择200例，其中男130例，女70例，年龄16~84岁，平均53.2岁。右侧腋静脉穿刺置管180例，左侧20例。结果经皮胸前区腋静脉穿刺一次穿刺成功175例，二次穿刺成功14例，三次穿刺成功7例，穿刺时退针回抽出静脉血32例(16%)。误穿动脉1例，经局部压迫止血未形成血肿。共196例穿刺成功，成功率98%。结论经皮胸前区腋静脉的穿刺置管法操作容易，成功率高，安全性高，并发症少，值得在临床推广应用。 　　[关健词]? 腋静脉；穿刺；置管 ??????????????????????????????????????????????????????????????????????????????? 　　Experience of percutaneous central venous catheterization through anterior region of chest　Abstract: Objective To evaluate the reliability and clinical parcticability of catheterization by venipuncture of axillary vein through anterior thoracic wall (IATAV).? Methods? Two hundred patients under general or epidural anesthesia received IATAV, 180 on the right side and 20 on the left side. The patients included 130 male and 70 female, aged from 16 to 84 years old (mean 52.3).?Results IATAV was successful in 98% of the patients, including sucessful puncture?at the first trial in 175 cases, at the second trial in 14 cases and at the third trial in 7 cases. The only complication was mistaken stabbing of axillary artery in 1 case, which did not cause hematoma after local compression. There were no pneumothorax, hemothorax or brachial nerve injury. Conclusion? IATAV is easy to carry out, highly successful and of less complications. It is a new feasible method for central vein puncture.?　Keywords: axillary vein; puncture; intubation ????????????????????????????????????????????????????????????????????????????????? 　　中心静脉通路已被广泛用于输液、给药、术中监护、中心静脉压测定和静脉营养等临床实践,同时穿刺的方法技术和材料不断更新。中心静脉置管可通过很多途径，颈内静脉和锁骨下静脉是目前采用最多的中心静脉置途径[1-2]。我科自2003年1月至2005年5月对需开放中心静脉患者随机选择200例，实施经皮胸前区腋静脉穿刺置管，取得满意效果，报道如下。 　　1 资料与方法 　　1.1 临床资料? ????????????????????????????????????????????????????????????????????????????????? 　　自2003年1月至2005年5月对需开放中心静脉患者随机选择200例，其中男130例，女70例，年龄16~84岁，平均53.2岁。 　　1.2 穿刺方法????????????????????????????????????????????????????????????????????????????????? 　　病人仰卧位，上肢位