颈外静脉高压注射碘对比剂安全性的评价

目的对颈外静脉高压注射碘对比剂的安全性进行评价，为穿刺特别困难者提供一条安全的增强检查途径。方法选择上肢静脉穿刺注射碘对比剂者为对照组（n=50）；选择颈外静脉穿刺注射碘对比剂为观察组（n=40），观察组均为上肢血管条件特别差、穿刺困难者。建立不同路径静脉高压注射碘对比剂评价表，其观察指标包括穿刺成功率、穿刺时间、渗漏率、碘对比剂剂量、注射速度、延迟时间、图像质量、不良反应发生率，以及注射前后心率、血压的变化等。结果对照组有1例穿刺失败，穿刺成功率为98％，无渗漏发生；观察组全部一次性穿刺成功，2例穿刺后等待检查过程中留置针滑出。对照组和观察组注射前后心率[（3．25±11．53）次／min比（-1．31±7．91）次／min]、舒张压波动值[（-6．75±24．24）mmHg比（3．04±8．82）mmHg]，两组比较差异无统计学意义（t分别为1．59，-1．91；P均〉0．05），收缩压波动值[（-2．60±13．09）mmHg比（7．39±13．52）mmHg]，两组比较差异具有统计学意义（t=-2．52，P〈0．05）；两组均无临床症状及碘对比剂不良反应发生，图像质量高；对血管条件特别差的患者选择颈外静脉穿刺提高了穿刺成功率，缩短了穿刺时间，减轻了患者的痛苦，只是技师在进行扫描时适当调整碘对比剂的剂量、扫描延迟时间。结论采用颈外静脉穿刺注射碘对比剂对于心功能正常者安全可靠，对穿刺特别困难者进行增强检查具有重要的临床价值。

Safety evaluation of high pressure external jugular vein injection of iodine contrast material

Objective To evaluate the safety of high pressure injection of iodine contrast material into the external jugular vein. Methods 50 cases who accepted the CM injection via upper extremity veins were chosen as the control group, 40 cases injected CM via external jugular vein were assigned to the observation group all of whose upper extremity veins were difficult to puncture. We designed an evaluation table to compare the two different high pressure vein injection methods, the observation indexes included： success rate of puncture, total time spend of puncture process, leakage ratio, dose of CM, injection speed, lag time, image quality, adverse effect incidence, heart rate and blood pressure changes before and after injection. Results There was 1 puncture failure in the control group, the success rate of puncture was 98% with no leakage cases. There was no puncture failure in the observation group except for two remaining needles slipped off after successful puncture. The variations of heart rate before and after puncture were [ （ 3.25 ± 11.53 ） beats/rain vs （ - 1.31 ± 7.91 ） beats/min ], diastolic pressure [ （ - 6.75 ± 24.24 ） mm Hg vs （ 3.04 ± 8.82 ） mm Hg ] in the control group and observation group, respectively, with no significant difference（t = 1.59, - 1.91 ;both P 〉 0.05）. However, the changes of systolic pressure were [ （ - 2.60 ± 13.09 ） mm Hg vs （ 7.39 ± 13.52 ） mm Hg ] , with statistically significant difference（ t = -2.52 ,P 〈 0.05 ）. No iodine contrast material related adverse effects happened in the two groups. The image quality were very high; Choosing external jugular vein puncture could improve the success rate of puncture, shorten the total time spend of puncture process and ease the pain of the patients, and the only added job was to adjust the dose of iodine contrast material and the lag time of screening. Conclusions Iodine injection via external jugular vein route is safe for patients with normal cardiac function, and it is an important method for those with poor vein condition.