提高锁骨下静脉穿刺盲穿成功率的临床研究

目的探讨不依赖于多普勒超声引导的锁骨下静脉穿刺置管方法。方法回顾性分析2014年1月至2019年2月西安医学院第二附属医院神经外科需进行锁骨下静脉置管术的128例患者的临床资料,患者均采用锁骨下静脉穿刺法静脉置管。观察患者的穿刺成功率及不良反应发生情况。结果128例患者在不依赖超声引导下锁骨下静脉置管过程中,一次穿刺成功95例(74.22%);经反复穿刺多次获得成功24例(18.75%);4例(3.12%)反复调整不成功,更换穿刺部位或超声引导下穿刺成功;穿刺不成功停止穿刺5例(3.91%)。128例患者穿刺置管中误穿动脉12例(9.38%),局部血肿形成6例(4.69%),气胸2例(1.56%),短期内(1周内)堵管17例(13.28%),菌血症2例(1.56%)。结论锁骨下静脉穿刺置管是神经外科患者常用、安全、有效的血管通路。掌握正确的锁骨下静脉盲穿方法是术者提高穿刺成功率、减少并发症发生的保障,不依赖多普勒超声适时引导减轻了患者的经济负担,值得临床推广。

Clinical study on improving the success rate of blind puncture of subclavian vein

Objective To explore the method of puncture and catheterization of subclavian vein without doppler ultrasound guidance.Methods The clinical data of 128 patients who needed subclavian vein catheterization in neurosurgery department of the second affiliated hospital of Xi'an medical university from January 2014 to February 2019 were analyzed retrospectively.All of them were given puncture and catheterization of subclavian vein,the success rate of puncture and adverse reactions were observed.Results In the course of catheterization of subclavian vein without ultrasound guidance in 128 patients,95 cases(74.22%)were successful in one puncture,24 cases(18.75%)were successfully punctured repeatedly,4 cases(3.12%)were unsuccessful in repeated adjustment,and successfully punctured after the puncture site was changed or under ultrasound guidance,5 cases(3.91%)were stopped after unsuccessful puncture.Among the 128 patients,12 cases(9.38%)had accidentally perforated the artery in the puncture catheter,6 cases(4.69%)had local hematoma formation,2 cases(1.56%)had pneumothorax,17 cases(13.28%)had blocked the catheter in the short term(within 1 week),and 2 cases(1.56%)had bacteremia.Conclusion Subclavian vein catheterization is a common,safe and effective vascular access for neurosurgical patients.Mastering the correct method of blind puncture of subclavian vein is the guarantee for surgeons to improve the success rate of puncture and reduce the occurrence of complications,and not rely on the timely guidance of doppler ultrasound to reduce the economic burden of patients,which is worthy of clinical promotion.