严重创伤患者不同部位中心静脉置管应用选择.doc

严重创伤患者不同部位中心静脉置管应用选择 　　摘要：目的 探讨严重创伤患者不同部位中心静脉置管的操作应用选择。方法 将180名严重创伤患者按穿刺部位不同随机分为三组，A组60例，锁骨下静脉置管组，B组60例，颈内静脉置管组，C组60例，股静脉置管组。结果 A组与B组及C组比较完成时间、穿刺失败率、堵管发生率、气胸发生率、心率失常发生率，B组及C组明显减少及降低，B组与C组比较以上指标，C组明显减少及降低。三种方法的感染率，A组及B组与C组比较，A组及B组明 显降低，A组与B组比较，A组明显降低。结论 三个穿刺部位均各有优劣，选择时应根据患者个体情况充分考虑，无论那个部位中心静脉穿刺， 操作中应该注意严格无菌， 掌握各穿刺部位静脉的走行及周围组织位置的解剖关系 关键词：严重创伤；中心静脉置管；穿刺部位 Abstract：Objective To investigate the operation application options for severe trauma patients in different parts of central venous catheter. Methods 180 patients with severe trauma at the puncture site were randomly divided into three groups， A group of 60 patients， subclavian vein catheter group， B group 60 cases， the jugular vein catheter group， C group 60 cases， femoral vein catheter group. Results Group A Group B and Group C completed the time， puncture failure rate， plugging the incidence， the incidence of pneumothorax， cardiac arrhythmia incidence of group B and group C decreased significantly and reduce the B and C groups above indicators， group C is significantly reduced and reduced. Three methods of infection rate in group A and group B compared with group C， group A and group B was significantly lower in group A compared with group B， group A was significantly reduced. Conclusion Three puncture site each has its own pros and cons， give full consideration to choose should be based on the individual patient， whichever parts of central venous puncture， operation should be noted that strict aseptic master the course and the surrounding tissue location of the puncture site of venous anatomy relationship. Key words：Severe trauma； Central venous catheterization； Puncture site 严重创伤患者紧急，迅速建立可靠的静脉通路是急救处置的关键措施，尤其是失血性休克的患者，需迅速恢复有效循环血量，维持重要器官的血液灌注。中心静脉置管是危重患者救治的常用技术，通常经皮肤穿刺将导管置留在深静脉（锁骨下静脉、颈内静脉、股静脉），目前已广泛应用于临床。2010年2月～2013年2月我科对180例严重创伤患者采用三种不同途径经皮深静脉穿刺置管， 现将其临床应用分析如下 1资料与方法 1.1一般资料 本组180例，男75例，女45例；年龄年龄18～65（38.6±16.3）岁；病种包括重型颅脑损伤，血气胸，肝脾破裂，全身多处骨折等多发严重创伤。将患者按穿刺部位不同随机分为三组，A组60例，锁骨下静脉置管组，B组60例，颈内静脉置管组，C组60例