血液净化改良超声引导法经皮颈内静脉穿刺置管术临床研究

摘要

目的：评估改良超声引导法经皮颈内静脉穿刺置管对血液净化患者临床应用效果，评价其安全性、可重复性。方法选取2008年2月－2014年8月在我院行血液净化治疗患者80例，随机分为2组：对照组40例根据体表标志进行颈内静脉穿刺置管；彩超组40例经我院B超室具有彩超操作资质专科医师超声术前引导划线，明确颈内静脉位置、走向、颈内动静脉血管关系、距皮深度，并通过剑突下两腔心和胸骨旁四腔心切面，在右心房观察导引钢丝进行颈内静脉穿刺置管。2组患者分别记录首次穿刺成功率、穿刺时间、出血情况、置管并发症、接管透析血流量等指标，进行对比分析。结果彩超组40例患者穿刺置管均获成功，无1例出现误穿动脉，穿刺置管出血量极少，无1例出现气胸等相关并发症。行血液净化治疗时血流效果满意，穿刺置管安全性、时效性、可重复性明显优于对照组（P＜0．05）。结论在改良超声引导下经皮颈内静脉穿刺置管，是一种快速简便，安全有效的方法，可重复性强，可以提高血液净化治疗建立临时性血管通路的简便性、安全性、可靠性，减少患者痛苦，行血液净化治疗血流充足可靠。%Objective To evaluate the effect, security,repeatability of clinical practice on blood purification through inter-nal jugular vein catheterization by modified ultrasound-guided method.Methods 80 patients receiving blood purification treat-ment in our hospital from February 2008 to August 2014 were randomly divided into a control group and an ultrasound group, each with 40 cases.The 40 cases in the control group underwent internal jugular vein catheterization by the marks on body sur-face.For the 40 cases in the ultrasound group,a specialist with ultrasound operation qualification conducted guide marking, specified internal jugular vein location,direction,relations of vein and artery in internal jugular,depth from the skin before un-dergoing internal jugular vein catheterization.The success rate of puncture,puncture time,bleeding,catheter complications,re-ceivership dialysis blood flow and other indicators for the two groups were separately recorded for the first time,and got ana-lyzed.Results The catheterization for the 40 patients in the ultrasound group was successful.No case of perforating arteries by mistake occurred,the amount of bleeding from catheterization was little,and no case was reported of pneumothorax and related complications.The blood flow was satisfactory in conducting blood purification treatment,and the security,timeliness,repeat-ability of catheterization are better than the control group(P<0.05).Conclusion Cathetering percutaneous internal jugular vein catheterization under the guidance of modified ultrasound is a fast,simple,safe and effective method.The repeatability is better.It can promote blood purification treatment for chronic renal failure and establish temporary vascular access.This method has advantages of simplicity,security,and reliability,and can reduce patients'pain.