实时超声引导成人颈内静脉穿刺置管的应用价值

摘要

目的：探讨实时超声引导在成人颈内静脉穿刺置管中的辅助作用，以评价其临床价值。方法180例需行颈内静脉穿刺置管的患者分为A、B两组（A组：按解剖部位行常规颈内静脉穿刺置管者100例；B组：实时超声引导下行颈内静脉穿刺置管者80例）。操作前简单评估穿刺难度及可能出现的并发症，分别记录准备时间、操作时间、穿刺次数、成功率及并发症等。结果 A、B组穿刺前评估颈内静脉穿刺置管困难者分别为15例和32例。A组89例置管成功（89%），B组80例均置管成功（100%），差异有统计学意义（P＜0．05）。B组穿刺困难者穿刺时间[（10．7±4．6）s]较A组明显缩短[（450．7±233．8）s]，差异有统计学意义（P＜0．05）。A组穿刺困难者一次穿刺成功4例，穿刺总成功率为60%，B组穿刺困难者一次穿刺成功27例，穿刺总成功率为100%。 A、B组发生误伤动脉、臂丛、血肿及气胸的几率分别为10.0％、2．0％、4.0％、1.0％和2.0%、1.0%、1.0%、0。结论实时超声引导可提高成人颈内静脉穿刺的成功率和安全性，尤其是穿刺置管困难的患者。%Objective To evaluate the role of real-time two-dimensional ultrasound guidance for internal jugular vein cannulation. Methods Totally 180 patients were divided into two groups, including group A(100 patients underwent conventional internal jugular vein cannulation ) and group B(80 patients underwent internal jugular venous cannulation under ultrasound-guidence). Before the operation, the difficulty of cannulation and possible complications were simply evaluated. During the operation,the prepared time,access time,number of attempts,success rate,one-attempt success rate and procedural complications were recorded. Results Fifteen cases were assessed to be difficult for cannulation of the internal jugular vein in group A and 32 cases in group B. Cannulation of the internal jugular vein was achieved in 89 patients(89%) in group A,and in all patients(100%) in group B,there was significant difference(P < 0.05). The average access time in group B[(10.7±4.6)s] was shorter than that in group A[(450.7±233.8)s],there was significant difference(P < 0.05). Four patients with difficult cannulation in group A were one-attempt success,the total success rate was 60%,while 27 patients with difficult cannulation in group B were one-attempt success,the total success rate was 100%. The occurence rates of accidently injure in artery and brachia plexus, pneumothorax and hematoma in group A and group B were 10.0%,2.0%,4.0%,1.0% and 2.0%,1.0%,1.0%,0. Conclusion Real-time two-dimensional ultrasound can significantly improve the success rate and safety of internal jugular vein cannulation.