颈外静脉留置针置管在小儿心脏外科手术中的应用

目的 分析颈外静脉留置针置管在小儿心脏外科手术中应用的可行性.方法 2011年3月～2013年4月河北医科大学附属哈励逊国际和平医院心脏外科手术患儿92例,分为中心静脉压组（CVP组）和颈外静脉压组（EJVP组）,每组各46例.CVP组患者右侧颈内静脉穿刺置入单腔中心静脉导管；EJVP组将Y型静脉留置针置入颈外静脉.观察记录两组患儿穿刺成功所需时间、穿刺次数、失败例数及相关并发症发生情况;持续监测并记录手术前（T1）、切开胸骨（T2）、主动脉插管（T3）、体外循环开始（T4）、体外循环中（T5）、停体外循环（T6）、主动脉拔管（T7）及术毕（T8）时EJVP和CVP.使用SPSS 19.0软件进行统计学分析.结果 两组患儿均通过颈内静脉和颈外静脉置管顺利完成静脉压监测、药物输注和术中补液,均未发生静脉炎、气胸、血胸及神经、气管损伤等并发症；EJVP组穿刺置管全部成功,CVP组3例穿刺置管失败,误穿颈内动脉2例；EJVP组穿刺所需时间[（3.0±1.2）min]明显短于CVP组[（11.0±3.1）min],穿刺一针成功例数（35例）多于CVP组（23例）,超过两针穿刺成功例数（3例）少于CVP组（10例）,差异均有统计学意义（P＜0.05）,两组两针穿刺成功例数、失败例数比较差异无统计学意义（P＞0.05）；EJVP和CVP均值在T1～T8时走形趋势一致,T1～T3、T6～T8时平均差值为（0.32±0.11）mm Hg,T4、T5时平均差值为（2.80±0.51）mmHg.结论 颈外静脉留置针穿刺置管可以安全、有效的用于小儿心脏外科手术中.

The application of venous indwelling needle with external jugular vein catheter in pediatric cardiac surgery

Objective To analyze the feasibility of the application of catheterization with external jugular vein catheter in pediatric cardiac surgery. Methods In Harrison International Peace Hospital of Hebei Medical University from March 2011 to April 2013, 92 cases of patients scheduled for Department of Cardiac Surgery were divided into two groups, central venous pressure （CVP group） and external jugular venous pressure group （EJVP group）. Each group had 46 cases. CVP group were placed single lumen central venous catheter in the right internal jugular vein; EJVP group were placed Y-type intravenous catheter into the external jugular vein. The time required for successful puncture, puncture frequency, the number of cases and related complications failure occurrence of two groups were observed and recorded; EJVP and CVP before surgery （T1）, sternotomy （T2）, aortic cannulation （T3）, start of CPB （T4）, car- diopulmonary bypass （T5）, stopping CPB （T6）, aortic extubation （TT） and surgery （T8） were continuously, monitored and recorded. SPSS 19.0 software was used for statistical analysis. Results Two groups of children successfully com- pleted venous pressure monitoring, drug infusion and intraoperative fluid infusion through the jugular vein and the external jugular vein catheterization and never occurred phlebitis, pneumothorax, hemothorax, nerve and tracheal injury and other complications; EJVP group cannulation was successful in all groups; Three cases of CVP group cannulation failure and two cases were punctured internal carotid artery mistakenly; EJVP group puncture time [（3.0±1.2） min] was significantly shorter than the CVP group [（11.0 ± 3.1） min]; the cases of punctured once success fully EJVP group （35 cases） were more than the CVP group （23 cases）; the number of eases over twice punctured successfully （3 cases） were less than CVP group （10 cases）. The differences were statistically significant （P 〈 0.05）. The differenees of two groups＇number of twice punetured sueeessfully and failed was not statistically signifieant （P 〉 0.05）. The values＇shape of EJVP and CVP took the same trend at T1-T8 mean. The average difference at T1-T3, T6-T8 was （0.32 ±0.11） mm Hg . At T4, T5, the average differenee was （2.80 ± 0.51） mm Hg. Conclusion The catheterization with external jugular vein catheter can be safely and effectively used for pediatric cardiac surgery.