超声导航术在婴儿中心静脉穿刺中的应用研究.doc

超声导航技术在婴儿中心静脉置管中的应用研究 韦华 邓劲松 钟志敏 张日英 李家胜 李波 梁真科 广东省高州市人民医院麻醉科 525200 【摘要】 目的 探讨超声导航技术在婴儿中心静脉穿刺中应用的价值。方法择期先天性心脏病手术患儿60例，随机分为超声导航组(Ⅰ组)和解剖标志组(Ⅱ 组), 每组均为30例, 超声组以超声图象定位、引导下穿刺颈内静脉, 解剖标志组则采用体表标志定位穿刺,分别观察记录两组患儿在每次操作过程中的一次穿刺成功率、总成功率、穿刺次数、穿刺时间、穿刺并发症等指标。结果 超声导航组的穿刺总成功率、一次穿刺成功率显著高于解剖定位组（P＜0.01）；穿刺时间、穿刺次数、穿刺并发症发生率均低于解剖定位组（P＜0.05）。结论 超声导航技术应用于婴儿颈内静脉穿刺可明显提高穿刺成功率、减少穿刺次数和穿刺时间，降低并发症发生率，是一种有必要开展的创新技术与手段。 【关键词】 超声；多普勒；导航；婴儿；中心静脉；静脉穿刺术；解剖标志;； Application of central vein catheterization by ultrasonic navigation technique in Infants WEI Hua,DENG Jingsong,ZHONG Zhimin,et al.Department of Anesthesiology, GAO-ZHOU PEOPLE Hospital . Guang-Dong 525200 CHINA 【Abstract】Objective To evaluate using ultrasound navigation at cannulation of the central vein in infant. Methods 60 cases with congenital heart disease sheduled for selective surgery were randomly divided into two groups, ultrasonic navigation group (groupⅠ) and anatomical landmark group (groupⅡ), 30 patients in each group. In group Ⅰ, cannulation was performed by using ultrasound scanner.While the patients’internal jugular veins(IJV) were cannulated by using the anatomical landmark location in group Ⅱ.And overall success rate , first puncturing success rate , number of needle passed,time on catheter insertion and some severe complications were noted.Results The overall success rate and first puncturing success rate of group Ⅰ was significantly higher than group Ⅱ, number of needle passed and time on catheter insertion of group Ⅰ were significantly lower than landmark group Ⅱ.Conclusinon Using ultrasound localization at cannulation of the IJV can significantly increase cannulation success rate , shorten the number of attempts and cannulation time and reduce the incidence of complication. Thus this technique was necessary to perform for clinic therapy. 【Key words】Ultrasound;Doppler;Navigation;Infant;Central vein;Venipuncture；Anatomy landwark mg/kg、咪达唑仑0.1mg/kg、阿托品0.01mg/kg作基础麻醉。常规监测ECG及SpO2，开放外周静脉。麻醉诱导采用静注芬太尼5μg/kg、维库溴铵0.2mg/kg，待