急诊深静脉穿刺置管206例临床分析

目的 比较手术室外行急诊颈内静脉与股静脉穿刺置管的优缺点.方法 手术室外行急诊深静脉穿刺置管患者206例,按照首次穿刺的血管分为右颈内静脉组110例和右股静脉组96例.分别记录2组的首次置管成功率、操作完成时间和并发症发生情况.采用SAS 6.04软件包对2组数据行t检验和非参数统计分析.结果 2组患者的病情、年龄、体重、性别相似,最终均完成深静脉穿刺置管,无气胸、心跳骤停等发生.右颈内静脉组首次成功率为88%(97/110),右股静脉组为100%(96/96)(P<0.05);右颈内静脉组操作完成时间为(21.5±8.4)min,右股静脉组为(12.5±5.3)min(P<0.05).右颈内静脉组有7例误穿动脉,其中4例血肿形成,而右股静脉组仅2例误穿动脉,无血肿形成.心电监护显示右颈内静脉组有6例发生心律失常(室性期前收缩、短阵室性心动过速),右股静脉组无心律失常发生(P<0.05).结论 手术室外危重患者的急诊深静脉穿刺置管选择股静脉为穿刺途径,具有安全简便、成功率高、并发症少的优点.

Application of emergency deep venous catheterization outside the operation room

Objective To evaluate the advantages and disadvantages of inserted internal jugular vein cathe-ters and femoral vein catheters in emergency patients outside the operation room.Methods 206 patients received right internal vein catheterization(group J,n=110)and right femoral vein catheterization(group F,n=96).Suc-cessful rates of puncture,operation time,incidence of complications were observed and compared between the two groups.SAS6.04 software was used to analyze the data of the two groups.Results Emergency deep venous catheter-ization was accomplished in all the patients.There were no severe complication in two groups,such as pneumothorax and cardiac arrest.The rate of successful puncture in group J was 88%(97/110),however,100%(96/96)in group F.There was statistical significant difference between two groups(P<0.05).Mean time needed in group J (21.5±8.4)m was more than that in group F(12.5±5.3)min(P<0.05).The cases of puncturing into artery or serious arrhythmia in group F(2 cases)were less than that in group J(7 cases including hematoma in 4 cases)(P<0.05).6 cases were found to have arrhythmia in group J but there was not arrhythmia in group F(P<0.05).Con-chsion Different ways of emergency deep venous catheterization should be selected according to different condi-tions of patients outside the operation room.For critically ill patients,femoral vein puncture is more safe,with high rate of Success and less complication.