右颈内静脉加压对颈内静脉穿刺置管术的影响

摘要

目的：探讨右颈内静脉加压对颈内静脉穿刺置管术的影响。方法：选取需进行右颈内静脉穿刺置管的低血容量性或脓毒性休克患者79例作为研究对象，随机分为对照组（C组）40例和颈内静脉加压组（P组）39例。所有患者均去枕平卧、Trendelenburg体位和头左侧偏转15°~30°，C组进行常规右颈内静脉穿刺置管，P组在C组基础上于患者右侧锁骨上窝靠近胸锁关节外侧凹陷处以食指中指二指并拢向内下方用力按压颈内静脉，以颈内静脉压瘪为宜。记录两组患者三次穿刺置管成功率、回血通畅率、穿刺失败率及血肿发生率。结果：P组穿刺置管成功率、回血通畅率、穿刺失败率及血肿发生率均优于C组，比较差异均有统计学意义（P<0.05）。结论：颈内静脉压迫明显有助于颈内静脉穿刺置管术的成功，减少了并发症。%Objective:To discuss the effect of right internal jugular vein pressure on internal jugular vein catheterization.Method:From May 2013 to March 2016,79 cases of low blood volume or septic shock with right internal jugular vein catheterization were selected as the research objects,they were divided into 40 cases of the control group(group C) and 39 cases of the internal jugular venous pressure group(group P).All patients had to lie,Trendelenburg position and the left side of the head deflection 15°-30°,group C were treated with conventional right internal jugular vein catheterization,group P was treated with an index finger and a middle finger were put together to push jugular veins hard inward and downward on the ipsilateral supraclavicular fossa near lateral recess of joints of the sternoclavicular joint until the veins were squashed based on group C,internal jugular vein press to make flat was appropriate.Three times puncture catheter success rate,the rate of return to blood,puncture failure rate and incidence of hematoma of two groups were recorded.Result:The puncture catheter success rate,the rate of return to blood,puncture failure rate and incidence of hematoma in group P were all better than those of group C,the differences were statistically significant(P<0.05).Conclusion:Internal jugular vein compression significantly contributes to the success of internal jugular vein catheterization and reduce complications.