超声引导下颈内静脉置管的临床研究.docVIP

超声引导下颈内静脉置管的临床研究 岑奕 夏建华 王喜安 姚滢 徐晓援 【摘要】 目的 探讨超声引导技术在成年患者颈内静脉置管中应用的临床价值。方法 选择需要右颈内静脉置管的消化道肿瘤手术患者120例，随机均分成3组，A组采用触摸颈动脉搏动和胸锁乳突肌三角定位下盲探穿刺，B组超声定位后穿刺，C组超声全程引导下穿刺。记录各组穿刺成功率、首次穿刺成功率、平均穿刺次数、成功置管平均所需时间、各种并发症（血肿、刺破动脉、气胸等）。结果 B、C组穿刺成功率（100%、100%）明显高于A组(PO．05)；B、C组首次穿刺成功率（85% 、97.5%）A组（60%）(PO．05)；B、C组成功插管所需次数明显少于A组(P0.05)；B、C组成功插管所需时间明显短于A组(PO．05)。B、C组无并发症，而A组出现3例颈部血肿、4例刺破动脉。结论 超声引导下的颈内静脉置管提高了穿刺成功率，降低了并发症，具有较大的临床应用价值。 【关键词】超声检查；颈静脉；置管 A clinical study of cannulation of the internal jugular Vein with ultrasound guidance CEN Yi, XIA Jianhua，Wang Xi’an, et al. Department of Anesthesiology,NO.411 hospital of PLA ,Shanghai 200081, China 【Abstract】 Objective To Evaluate the utilization and effect of ultrasound scanner in percutaneous cannulation of the internal jugular vein for adult patients．Methods 120 patients undergoing elective surgery for digestive tumor were randomized into three groups. In the AL(anatomical landmark )group, the landmark for cannulation was the palpation of the common carotid pulsation or the sternocleidomastoid triangle. In the UL(ultrasound prelocation) group, the central vein was located by 2D-ultrasonic imaging. In UD(ultrasound guidance) group ,the cannulation was conducted by ultrasound all the time. Success rate, once success rate, the number of cannulation attempts, operation time and complications (hematoma, artery puncture, pneumothorax) were recorded. Result Compared with AL group, success rate in UL and UD group were increased significantly. The cannulation success rate in UL and UD group on once time were (85%) and (97.5%) respectively, which was better than that in AL group (60%) obviously (p0.05). The number of cannulation attempts in UL,UD group are less than that in AL group (p0.05). Operation time in UL and UD group were less than that in AL group distinctly (p0.05). There were no complications except AL group (3 cases of hematoma, 4 cases of artery puncture). Conclusion Ultrasound-guided cannulation of internal jugular vein is good for i