Objective To evaluate the clinical value of ultrasound-guided subclavian vein puncture to central venous catherization. Methods A total of 480 patients who intended to receive subclavian vein catherization puncture from October, 2005 to August, 2009 were randomly divided into two groups: the contrast group and the ultrasound group. The subjects in the contrast group took blind puncture of body-surface localization, while those in the ultrasound group had real-time ultrasound-guided puncture. The achievement ratio, the time for the incidence rate of complication and the dwell time were observed. Results In the ultrasound group, the first achievement ratio, second and third achievement ratio were 223 ( 92. 9％ ), 14 (5.8％ ) and 3( 1. 3％ ), respectively. The failed cases and total achievement ratio were 0 and 100％ ,While these in contrast group were 190( 79. 2％ ),25( 10.4％ ) and 9( 3. 8％ ), respectively. The failure cases and total achievement ratio were 14. 0％ and 90. 6％ . According to first achievement ratio and failure rate, there was statistical significance between the two groups ( P ＜ 0. 01 ). The puncture time of ultrasound group 4. 8 ±2. 1 min was shorter than that 13. 5 ±3.0 min of contrast group ( P ＜ 0. 05 ), while the dwell time were 31. 3 ± 8. 5 min to 21. 6 ± 7. 8 min ( P ＜ 0. 01 ). The number of cases with complications were 2 to 22 ( P ＜0. 01 ). There were 10 cases of anatomical variations in ultrasound guided group: the subclavian veins and and the internal jugnlar veins were crossed above the sternoclavicular joints, which were punctured successfully by ultrasonic imaging method. Conclusion The subclavian vein puncture to central venous catherization process and its location can be observed under the ultrasound guidance. Then the catherization departure prolapse and thromb hidden trouble can be found with timely treatment in order to effectively avoid complications.%目的 探讨超声在锁骨下静脉中心静脉置管术的应用价值.方法 自2005年10月至2009年8月, 将480例拟实施锁骨下静脉穿刺的患者随机分为对照组(常规体表定位盲穿法)和超声组(超声实时引导下穿刺),观察并比较置管一次成功率、置管穿刺所需时间、并发症发生率、留管时间.结果 超声组1次、2次、3次穿刺成功分别为223例(92.9%)、14例(5.8%)、3例(1.3%),穿刺失败0例,总成功率100%;对照组1次、2次、3次穿刺成功分别为190例(79.2%)、25例(10.4%)、9例(3.8%),穿刺失败16例,成功率93.4%;两组1次穿刺成功率和穿刺失败率的差异均有统计学意义(P均＜0.01).超声组平均穿刺时间为(4.8±2.1)min,短于对照组的(13.5±3.0)min(P＜0.05).超声组2例出现并发症,对照组22例出现并发症,两组差异有统计学意义(P＜0.01).超声组导管平均留置时间为 (31.3±8.5) d,明显长于对照组的(21.6±7.8) d(P＜0.01);超声组发现解剖变异10例(4.1%),锁骨下静脉与颈内静脉于胸锁关节上方汇合,均在超声引导下于锁骨上成功置管.结论 超声在锁骨下静脉中心静脉置管中引导精确,置管完毕后可用超声观察导管位置,及时发现和处理导管偏离、脱出和血栓隐患,能有效避免并发症的发生,减少危重患者体位不适及疾病带来的风险,穿刺时间短,留置导管时间长,尤其对于穿刺困难患者,有重要的临床使用价值.
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