三维超声引导下经皮脐静脉穿刺术的应用价值

目的探讨应用三维超声引导在经皮脐静脉穿刺术中的价值。方法回顾性分析69例行二维超声引导下经皮脐静脉穿刺术及74例行三维超声引导下经皮脐静脉穿刺术孕妇的临床资料，比较两种方法脐静脉穿刺的成功率。结果二维超声引导下脐静脉穿刺术总成功率97．10％，其中一次穿刺成功率57．97％，二次穿刺成功率23．19％，三次穿刺成功率15．94％。二维超声前两次穿刺成功率为81．16％。三维超声引导下脐静脉穿刺术总成功率98．65％，其中一次穿刺成功率56．76％，二次穿刺成功率40．54％，三次穿刺成功率1．35％。三维超声前两次成功率为97．30％。三维超声引导下经皮脐静脉第二次穿刺成功率及前两次穿刺成功率均优于二维超声（P〈0．05）。结论三维超声引导下经皮脐静脉穿刺可以显示穿刺针针尖及针杆，在一次穿刺失败后可以利用多平面成像、表面成像、透明成像等模式观察穿刺针与脐静脉的位置关系，从而及时调整，提高第二次穿刺成功率。

Application value of percutaneous umbilical blood sampling under three-dimensional ultrasound guidance

Objective To explore the value of percutaneous umbilical blood sampling （PUBS） under three - dimensional ultrasound guidance. Methods The clinical data of 69 cases under two - dimensional ultrasound - guided PUBS and 74 cases under three - dimensional ultrasound - guided PUBS in prenatal diagnosis were analyzed retrospectively, then the success rate of umbilical blood sampling was compared. Results The general achievement ratio of two - dimensional ultrasound - guided PUBS was 97.10% , including the first puncture achievement ratio of 57.97% , the second puncture achievement ratio of 23.19% , the third puncture achievement ratio of 15.94%, the total achievement ratio of the first and second punctures were 81.16%. The general achievement ratio of three - dimensional ultrasound - guided PUBS was 98.65% , including the first puncture achievement ratio of 56.76% , the second puncture achievement ratio of 40.54%, the third puncture achievement ratio of 1.35% , the total achievement ratio of the first and second punctures were 97.30%. The second puncture achievement ratio and the total achievement ratio of the first and second punctures of three - dimensional ultrasound - guided PUBS were better than those of two - dimensional ultrasound - guided PUBS （P 〈 0.05）. Conclusion The needle tip and needle bar can be displayed in three - dimensional ultrasound - guided PUBS. After the failure of the first puncture, multi - planar imaging, surface imaging and transparent imaging model can be used to show the position relationship of needle tip, needle bar and umbilical vein, then we can adjust the needle tip to improve the second puncture achievement ratio.