低位颈内静脉穿刺置管法的改良及临床应用

目的改良低位颈内静脉的穿刺置管方法并进行临床验证.方法选择肝胆手术病人共400例行右侧颈内静脉穿刺置管,穿刺点定位在胸锁乳突肌前缘,锁骨上缘约2.0～2.5cm,穿刺针方向针对胸锁乳突肌的锁骨头外侧缘.结果试穿成功率统计,首次试穿成功354例(88.50%),2次试穿成功为38例(9.50%),3次以上试穿成功为8例(2.00%);正式穿刺置管成功率统计,首次穿刺置管成功349例(87.25%),2次穿刺置管成功37例(9.25%),3次以上穿刺置管成功9例(2.25%),改用其他途径穿刺置管成功5例(1.25%).误穿动脉4例(0.10%),无1例发生气胸等严重并发症.结论改良的低位颈内静脉穿刺置管方法,具有操作简单快捷,穿刺成功率高,并发症少等优点,是一种值得推广的颈内静脉穿刺置管方法.

Modification of low - located catheterization of the internal jugular vein and its clinical application

Objective:To modify the method of the low-located catheterization of internal jugular vein and verify its clinical application. Methods: 400 cases of the patients with hepatobiliary surgeries were randomly selected for right internal jugular vein catheterization. The site for puncture is located at the anterior edge of the sternocleidomastoid muscle, 2.0~2.5cm above the superior edge of clavicle. The direction of the puncture needle is toward to the lateral border of the clavicular head of sternocleidomastoid muscle. Results:The successful rates of times of the initial puncture showed that 354 cases (88.50%) underwent only one time puncture, 38 cases(9.50%)underwent twice and 8 cases(2.00%) underwent 3 times or more respectively. Five cases were changed to choose the other alternative pathways. The successful rates of the times of formal puncture and catheterization were that one time puncture and catheterization in 349 cases(87.25%), twice in 37 cases(9.25%)underwent twice and 3 times or more in 9 cases(2.25%). Five cases were adapted to other alternative pathways to achieve the success of catheterization. Arterial puncture occurred in 4 cases( 0.10% ).None of the pneumothorax or other serious complications happened. Conclusions:The modified method for internal jugular vein catheterization in low-located site is a very convenient maneuver, which is easy to handle, with high successful rate and decreased complications. It is worth to be widely utilized in clinical practice.