目的 分析儿童颈内中心静脉穿刺置管的机械性并发症,探讨其预防策略.方法 选择2006年8月至2009年10月728例接受颈内中心静脉穿刺置管术的患儿,分别记录性别、年龄、体质量、导管类型、穿刺次数、机械性并发症(包括心律失常、误穿动脉、气胸、血胸、局部渗血与血肿、导管移位、钢丝缠绕).结果 穿刺1次成功率为58.65%,穿刺2次成功率为18.68%,穿刺3次及以上成功率为22.39%.728例颈内中心静脉穿刺置管术早期机械性并发症发生率为11.68%,其中心律失常10例(1.37%)、误穿动脉27例 (3.71%)、气胸5例(0.69%)、血胸4例(0.55%)、局部渗血和血肿16例(2.20%)、导管移位15例(2.06%)、钢丝缠绕或丝轴分离3例(0.41%),其他5例(0.69%).结论 儿童经颈内中心静脉穿刺置管切实可行,但穿刺针、导丝、扩张器、导管不宜置入过深,必要时应用超声引导穿刺.%Objective To analyze the mechanical complications of internal jugular central venous catheterization in children,and to discuss their prevention strategies. Methods 728 children undergone internal jugular central venous catheterization from August 2006 to October 2009 were selected. Their gender, age, body mass, types of catheters, times of puncture and mechanical complications (including arrhythmia,accidental arterial puncture,pneumothorax,hemothorax,local errhysis and hematoma,catheter displacement and intertwined guide wire) were recorded respectively. Results The first attempt success rate of puncture was 58. 65% , the second was 18. 68% ,and the third or more than third was 22. 39%. The incidence rate of mechanical complications in early stage of internal jugular central venous catheterization in 728 children was 11. 68%. Among them,there were 10 cases (1. 37%) of arrhythmia ,27 cases (3. 71%) of accidental arterial puncture,5 cases (0. 69%) of pneumothorax,5 cases (0. 55%) of hemothorax, 16 cases (2. 20%) of local errhysis and hematoma,15 cases (2. 06%) of catheter displacement, 3 cases (0. 41%) of intertwined guide wire or wire-axis separation and 5 cases (0. 69%) of others. Conclusion It is practical and feasible for children receiving internal jugular central venous catheterization, with insertion of needle, guide wire, dilator and catheter not too deep and application of ultrasound-guided puncture if necessary.
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