超声引导下经皮右颈内静脉穿刺置管术在血液透析中的应用

目的探讨超声引导下经皮右颈内静脉穿刺置管术在血液透析中的应用,分析超声引导穿刺的方法、注意事项及并发症预防。方法对297例慢性肾功能不全尿毒症患者进行超声引导下经皮右颈内静脉穿刺置管术,按照提高一次穿剌成功率的技术要点进行操作。结果本组患者均获得穿剌置管成功,其中244例1次穿刺成功（244/297,82.15%）,30例第2次穿刺成功（30/297,10.10%）,23例第3次穿刺成功（23/297,7.74%）。并发症发生率为15.15%（45/297）,31例因导管贴壁导致引血不畅流量不足。结论实时超声引导在右颈内静脉穿刺置管术中的应用,可极大提高穿剌的一次成功率,有效降低并发症的发生。

Clinical application of ultrasound guided percutaneous right internal jugular vein catheterization in hemodialysis

Objective To explore the clinical application of ultrasound guided percutaneous right internal jugular vein catheterization in hemodialysis, and to analyze the methods, precautions and prevention of complications of puncture. Methods Totally 297 patients of chronic renal insufficiency with uremia underwent ultrasound guided percutaneous right internal jugular vein catheterization according to technical points of increasing the success rate of puncture. Results The total successful rate of puncture was 100%. The first puncture succeeded in 244 patients (244/297, 82.15%), the second in 30 (30/297, 10.10%) and the third in 23 (23/297, 7.74%) patients. The complication rate was 15.15% (45/297). Poor adherence of catheter led to cited blood difficultly and inadequate flow in 31 patients. Conclusion Ultrasound guidance can greatly improve the success rate of puncture in percutaneous right internal jugular vein catheterization, while reduce the incidence of complications.