超声定位与实时引导右颈内静脉穿刺置管用于急诊血液透析的价值

目的：通过与体表解剖法比较、探讨术前超声定位与术中动态引导右颈内静脉穿刺置管用于急诊血液透析患者的价值。方法：拟行急诊血液透析患者90例,ASAⅡ～Ⅳ级,随机分为3组,（n=30）,所有患者均去枕平卧,头左偏30°体位,于环状软骨平面穿刺。A组：体表解剖法组,依据体表解剖标志定位,行右颈内静脉中路法穿刺置管。B组：超声定位组,术前超声定位,并标记右颈内静脉,穿刺置管。C组：超声动态引导组,使用便携式彩超定位,全程引导右颈内静脉穿刺置管。分别记录穿刺次数及一次穿刺成功率,操作时间,早期穿刺并发症等情况。结果：C组1例失败,B组有2例失败,A组5例失败。与A组比较,C组穿刺次数少（P〈0.05）,一次穿刺成功率、一次置管成功率高（P〈0.01）,无误穿动脉（P〈0.05）,但穿刺时间最长（P〈0.05）。与B组比较,C组操作时间更长（P〈0.05）。结论：急诊血液透析患者右颈内静脉穿刺前常规超声定位,有利于提高一次穿刺置管成功率,缩短穿刺时间,减少并发症发生。对于解剖变异或穿刺困难者宜采用超声实时引导。

The Value of Ultrasound Preoperative Localization and Real-time Ultrasound-guided Right Internal Jugular Vein Catheterization Using in Patients of Emergency Hemodialysis

Objective：Discussing the value of ultrasound preoperative localization and real-time ultrasound-guided right internal jugular vein catheterization during operation using in patients of emergency hemodialysis through comparing with the method of anatomical landmark.Methods：90pcs emergency hemodialysis patients,ASA Ⅱ~Ⅳ level,are divided into three groups randomly（n=30）：group A,group B and group C.All patients were placed prostration without pillow and 30°headrotation to left.At annular cartilage level,ultrasound probe was placed vertical to skin of neck.Group A is as surface anatomy group.According to surface anatomy location by landmark,doing Percutaneous RIJV cannulation.Group B is as ultrasound location group.Ultrasound preoperative locating,marking RIJV catheterization.Group C is as ultrasound dynamic guiding group.Using portable colorful ultrasound location to guide RIJV catheterization during all process.We need to report all probing quantity,probing successful rate,operating time,and probing complications in earlier stage and so on.Results：One example is failed during group C,and two ones for group B and five ones for group A.Comparing with group A,group C probing quantity is less（P0.05）,successful rate is higher for centesis and catheterization for one time（P0.01）.Do not probe artery wrongly（P0.05）,but it used longest time（P0.05）.Comparing with group B,group C used more handling time（P0.05）.Conclusion：The way which is General Ultrasound location is used on RIJV of emergency hemodialysis patients before operation can increase successful rate of catheterization,shorten centesis time and reduce happening of complications.It also can be used real-time ultrasound-guided for patients of anatomy aberrance and hard centesis.