锁骨下静脉的解剖特点与上腔静脉置管路径的研究

目的　研究锁骨下静脉走向 ,探讨经此路径行上腔静脉置管的最佳方法 ,并分析相关并发症的原因。方法　对6 8例锁骨下静脉穿刺上腔静脉置管的临床病例进行造影透视、摄片 ,统计最适宜的置管长度 ,比较改良穿刺技术与旧Seldinger技术的效果及与相关并发症的关系。结果　锁骨下静脉穿刺上腔静脉置管的长度右侧为 (8.5 +d)cm(d为穿刺点至锁骨头上缘距离 ) ,左侧为 (11.5 +d)cm。原Seldinger技术一次置管成功率为 75 0 % ,改进后为 92 .5 % ;原操作方法置管操作时间为(43 3± 10 9)min ,改良后为 (2 8 6± 10 3)min ;原方法并发症发生率 39 2 9% ,改进后为 10 0 % ,差异均有显著性 (P <0 0 1)。结论　置管长短主要取决于穿刺点距锁骨头上缘的距离 ;改良穿刺技术是一种安全、有效的中心静脉置管方法 ,选择右侧路径比左侧更安全

The research of subclavian vein anatomy character and the superior vena cava catheterization path

Objective To investigate the subclavian vein tends toward and found the best way to catheterize by this path,analysed the causation of the concomitant symptom.Methods Sixty eight clinical cases who had received subclavian vein puncture and catheterization were taken clairvoyances and photograghs.The meliorating puncture skill (the new way)with the old seldiager skill(the old way),and compared with their connetion of concomitant symptoms were Compared.Result Subclavian vein puncture,their anatomy supeior vena cava length was (8 5+d)cm in right side,(11 5+d)cm in left side.D was delegate of the distance from the puncture dot from clavicle bone head. The old way′s once time succesful rate was 75%. But the new way was 92 5%. The old way spent (43 3±10 9)min to finish puncture. The new way′s concomitant symptom happened for 39 2%. The new way happened for 10 0%.The difference between two ways was markedness(P<0 01).Conclusions The catheterization length depends on distant from puncture dot to clavicle bone head. The meliorating skill is a safe.Efficiency way of the center vena cava catherization. It is more safe to choose the right side than left side.