超声引导下腋-锁骨下静脉穿刺的临床效果

摘要

目的 通过比较传统的体表定位和实时超声引导穿刺方法,观察实时超声引导下腋-锁骨下静脉穿刺方法的有效性.方法 择期手术需行中心静脉穿刺患者 142 例,男 73 例,女 69 例,年龄 19~85 岁,ASA Ⅰ~Ⅲ级,随机分为两组:传统定位组(T组,n=71)用传统的体表定位方法行腋-锁骨下静脉穿刺置管;实时超声引导穿刺组(U组,n=7 1 )先探头置于锁骨中线处,与锁骨水平夹角成 30~40°,探头纵切面与人体冠状面夹角呈 60°左右,超声图像上清晰显示静脉长轴,采用平面内技术进行穿刺.记录穿刺时间、次数、并发症,计算一次成功率、二次成功率和失败率.结果 U 组穿刺时间明显短于T组[(5.02±2.05)min vs (14.02±3.98)min,P<0.05].U组的一次成功率明显高于T组(95.8% vs 67.6%,P<0.05).T组和 U 组分别有 2 例和 3 例误入颈内静脉.T 组发生气胸、误入动脉和血肿例数分别为 1 例、3 例和 2 例,U 组未见上述并发症(P<0.05 ).结论 实时超声引导下腋-锁骨下静脉穿刺,效果优于传统的体表定位方法,值得临床推广.%Objective To compare clinical effectiveness of real-time ultrasound-guided axillary-subclavian vein catheterization with that of the traditional technique.Methods A total of 142 patients who were intended to receive central venous catherization puncture,73 males and 69 females,aged 19-85 years,were randomly divided into two groups:traditional puncture of body-surface localization group (group T,n=71);real-time ultrasound-guided puncture group (group U,n=71),the probe was placed at the midline of the collarbone,30-40°horizontal to the clavicle,forming approximately a 60°angle between the longitudinal section of the probe and the coronal plane of the human body, showing the long axis of vein clearly,then in the long axis view puncture was performed.Time re-quired for catheterization,the number of needle advances and complications were recorded.The first-time success rate and the second-time success rate and failure rate were calculated.Results Puncture time of group U was significantly shorter than that of group T [(5.02±2.05)min vs (14.02±3.98) min,P<0.05].The first-time success rate of group U were higher than that of group T (95.8% vs 67.6%,P <0.05).The complication rate of group U was lower than that of group T (P<0.05). Catheter misplacements did not differ between the two groups.Conclusion Real-time ultrasound guided axillary-subclavian vein puncture is superior to the traditional technique and is worthy of clinical promotion.