改良婴幼儿中心静脉置管的临床应用

目的探讨改良婴幼儿中心静脉穿刺置管术的临床应用价值。方法随机抽取年龄30天-3岁，体重3．70～15．0kg行先心病手术的婴幼儿60例分为2组（n=30）。A组：对照组，首选右颈内静脉中路，用20GY形穿刺针穿刺，回血通畅后经Y型穿刺针置入J形引导钢丝，然后沿导丝置入中心静脉导管。B组：改良组，在彩超引导并实时监测下用18GBD静脉留置针穿刺，回血通畅后经静脉外套管置入J形引导钢丝，然后沿导丝置入中心静脉导管。记录两组穿刺置管总成功率、一次穿刺成功率、失败率及并发症。B组记录彩超引导下不同路径和头位颈内静脉距皮肤距离，颈内静脉横截面积，颈内静脉与颈总动脉重叠程度。结果B组总穿刺成功率高于A组（P〈0．05），B组一次穿刺成功率显著高于A组（P〈0．01），B组的穿刺并发症明显低于A组。结论彩超引导并实时监测下经18G静脉留置针穿刺置管，大大提高了婴幼儿中心静脉置管的成功率，并降低了并发症的发生率，有很高的临床应用价值。

The clinical value of improved central venous puncture catheterization in children

Objective： To investigate the clinical value of improved central venous puncture catheterization in children. Methods： Totally ,60 cases aged 30 d-3 yr,weight 3.70-15.0kg,undergoing congenital heart disease surgery were randomly divided into 2 equal groups of 30 patients. （ Control group with right internal jugular vein catheterization via midway approach ,while experimental group with central venous catheterization guided by ultrasound）. （1）The overall success rate of puncture, （2） the success rate and failure rate of puncture at first attempt, and （ 3 ） complication were recorded. Results ： The over-all success rate and the success rate of puncture at first attempt in experimental group were significantly higher than those in control group （ P 〈0. 05 and P 〈 0.01）. The complication in experimental group was lower than those in control group. Conclusion： Central venous catheterization guided by ultrasound is a reliable and safe technique in children.