超声引导技术在新生儿颈内静脉穿刺置管中的应用

摘要

目的观察超声引导技术在新生儿(包括低体重儿)颈内静脉穿刺置管中的应用.方法 选取62例行胸腹部手术及体表大肿瘤切除术的新生儿(包括低体重儿),随机分成超声引导组(UG组)及体表标志定位组(S组),两组均先使用22G静脉留置针,穿刺置入外套管成功后,再行钢丝引导法置入双腔中心静脉导管.观察两组穿刺操作的成功率、更换穿刺点的次数、穿刺并发症及平均穿刺时间.结果 UG组的穿刺成功率为96.8%(30/31),明显高于S组的32.3%(10/31),差异有统计学意义(χ2=28.182,P=0.000);UG组的更换穿刺点的例数(2例)亦明显低于S组的例数(25例);穿刺并发症发生率为3.2%(1/31),亦低于S组的64.5%(20/31),差异有统计学意义(χ2=25.995,P=0.000);UG组平均穿刺时间为(4.366±1.137) min,S组平均穿刺时间为(13.70±5.34)min,两组比较差异有统计学意义(t=5.463,P=0.028).结论 超声引导新生儿颈内静脉穿刺是安全可行的技术,可极大提高穿刺成功率和减少穿刺并发症的发生.%Objective To investigate the application of the ultrasonic guidance-assisted neonatal internal jugular vein catheterization.Methods Sixty two newborns (including low birth weight infants) receving thoracic/abdominal operation or resection of malignant tumor on the body-surface were randomly assigned to ultrasound guidance (UG) group or surface mark landmark(S) group.Newborns in both groups were all punctured with 22G venous indwelling needles to place the external casing,followed by the steel wire guidance-assisted implantation of ARROW 4F dual chamber central venous catheter.Then we compared the rate of successful insertion attempt,rate of malpositioning,complications and average operation time between the two groups.Results The rate of successful insertion attempt was 96.8%(30/31) in the UG group,significantly higher than that in the S group (32.3%,10/31),there was significant difference between the two groups(χ2=28.182,P=0.000).Malpositioning happened in 2 cases in the UG group,but 25 cases in the S group.Rate of complications was higher in the S group compared to the UG group (64.5% vs 3.2%,χ2=25.99,P=0.000).Most importantly,the average operation time was (4.366±1.137)min in the UG group,significantly shorter than that of the S group [(13.70±5.34)min,t=5.463,P=0.028)].ConclusionUltrasound guidance-assisted catheterization for neonatal internal jugular vein is safe and feasible and can dramatically improve the success rate and prevent complications.