不同超声引导平面技术在颈内静脉穿刺置管术中的临床应用

目的比较长轴平面、短轴平面和斜轴平面超声引导下颈内静脉穿刺置管的临床效果,探讨最佳的穿刺引导平面。方法选择昆明医科大学第一附属医院急救医学部EICU收治的患者180例,男94例,女86例,年龄34~82岁,按前瞻性随机试验方法分为短轴平面组、长轴平面组和斜轴平面组,每组60例。在超声引导下使用三种不同的引导平面行颈内静脉置管术,记录三组刺入目标血管时间、总穿刺时间、穿刺针进针改变方向的次数、穿刺点数量和置管成功率。记录三组颈内静脉置管的并发症(气胸、血肿和误穿动脉)。结果三组患者均顺利完成超声引导下颈内静脉穿刺置管术。短轴平面组和斜轴平面组刺入目标血管时间和总穿刺时间明显短于长轴平面组,斜轴平面组刺入目标血管时间和总穿刺时间明显短于短轴平面组(P0.05);三组穿刺点数量差异无统计学意义;短轴平面组进针改变方向次数最多,斜轴平面组进针改变方向次数最少(P0.05);斜轴平面组误穿动脉发生率明显低于长轴平面组和短轴平面组(P0.05),三组均未发生气胸、血胸。结论与长轴平面和短轴平面比较,使用斜轴平面行颈内静脉穿刺置管术可降低危重患者行颈内静脉穿刺置管术中误穿颈总动脉的风险和缩短穿刺时间,是安全而有效的超声引导下颈内静脉穿刺路径。

Optimal axis plane for ultrasound-guided approach for internal jugular vein catheterization

Objective To evaluate the clinical effects of ultrasound-guided internal jugular vein catheterization in long axis plane,short axis plane and oblique axis plane,in order to identify the opti-mal axis plane for this procedure.Methods One hundred and eighty patients (male 94 cases,female 86 cases,aged 34-82 years)requiring ultrasound-guided internal jugular vein catheterization were in-cluded in this study.They were randomly divided into three groups (n =60 each),long axis group, short axis group and oblique axis group,with 60 cases in each group.The details of catheterization in-cluding the time accessing into vein,the time finishing cannulation,needle redirecting times,number of skin points of puncture,puncture successful rate and complications in the three groups were recor-ded.Results Compared with long axis plane and short axis plane,the oblique axis plane was associat-ed with decreased time for venous access and cannulation.The oblique axis plane also needed less changes of needle direction.The complication of arterial puncture in the oblique axis plane group was significantly lower than long axis plane group and short axis plane group(P <0.05).The number of skin puncture points were similar between the three groups.Conclusion The oblique plane can provide a safe and more effective route to perform the IJV catheterization with minimal risk for carotid artery puncture,which demonstrates the practical superiority over the classic short axis plane and long axis plane for critically ill patients.