实时超声引导在60例早产儿脐静脉置管术中的应用研究

目的 探讨实时超声引导在早产儿脐静脉置管术的应用价值。方法 通过对需进行脐静脉置管的60例早产儿进行实时超声引导脐静脉置管,置管前应用高频探头测量引导路径各段的长度,估算导管插入长度,置管术中根据超声测值预判导管顶端置于脐静脉肝内段时开始进行实时超声引导,缓慢引导导管顶端通过门静脉左支囊部、静脉导管到达下腔静脉内,而未进入右心房内,回抽血顺利,固定导管后,超声扫查再次确认导管顶端置于下腔静脉内,引导结束。结果 60例研究对象中脐静脉置管一次性置管成功率达93.3%(56/60);术前超声测量引导路径预判导管插入深度(7.70±0.72)cm,实际置管深度(7.59±1.20) cm,差异无统计学意义(P=0.574)。结论 实时超声引导下脐静脉置管的一次性置管成功率高,具有很好的导航作用,且可明确置管失败的原因;术前应用超声检查可观察置管路径各段的情况,且术前超声测量引导路径预判导管插入深度可给实际置管提供参考。

Study on the application of real-time ultrasound-guided in umbilical vein catheterization in 60 premature infants

Objective To evaluate the clinical value of real-time ultrasound guided in umbilical vein catheterization. Method sA total of 60 premature infants requiring umbilical vein catheterization were chosen in this study and real-time ultrasound guided umbilical vein catheterization was performed in these infants.High frequency probe was used to measure the length of all paths to estimate the depth of duct insertion.Real-time ultrasound guided started when the top of duct placed in the intrahepatic segment of umbilical vein,then the top of duct reached the inferior vena cava not right atrium through the lateral branch of the left portal vein and venous duct.Ultrasonic scan was conducted to confirm the top of duct was inside the inferior vena cava after the duct was fastened. Results The one-time successful rate of the umbilical vein catheterization with real-time ultrasound guidance was 93.3%.The depth of duct insertion which preoperative measured by ultrasound was (7.70±0.72) cm,and the actual depth of umbilical venous catheters was (7.59±1.20) cm.There was no significant difference between these two depths (P=0.574). Conclusions The real-time ultrasound guided umbilical vein catheterization can improve the successful rate,which plays a good navigation effect.Preoperative ultrasound application can check the paths of all insertion paragraphs,and the preoperative measurement through ultrasound could guide the actual catheter.