床旁彩超定位在危急患者困难颈内静脉置管中的应用

目的探讨床旁彩超在危急重症患者困难颈内静脉置管中的应用和效果。 方法回顾性研究2017年9月至2019年3月在徐州医科大学附属宿迁医院急诊行颈内深静脉置管的患者116例，其中男性60例，女性56例；年龄13～83岁，平均(44.5±6.8)岁，所有患者中彩超定位组57例，传统体表解剖定位组59例，统计两组患者的置管时间，置管成功率，误穿动脉数，局部血肿，气胸等情况。 结果彩超定位组患者置管时间5.32 min，一次置管成功率100%，误穿动脉数0例，局部血肿0例，而传统体表解剖定位组置管时间11.13 min，一次置管成功率74.6%(44例)，二次置管成功率86.4%(51例)，二次置管未成功转为彩超定位后均一次成功，误穿动脉5例，局部血肿9例。 结论床旁彩超定位在危重症颈内静脉置管中具耗时短，且有较高的成功率，并发症低，符合急诊治疗的需求，应用效果好，尤其适用于局部解剖定位不清的危重患者，并且在实习生教学及低年资医师带教中更容易被理解和掌握、可以广泛开展应用。

Application of bedside color Doppler ultrasound in difficult internal jugular vein catheterization in critical patients

ObjectiveTo explore the application and effect of bedside color Doppler ultrasound in difficult internal jugular vein catheterization in critical patients. MethodsWe conducted a retrospective analysis of 116 patients with deep jugular vein catheterization in emergency department of the Affiliated Suqian Hospital of Xuzhou Medical University from September 2017 to March 2019, including 60 males and 56 females, aged from 13 to 83 years, with an average age of (44.5±6.8) years, including 57 patients in color ultrasound localization group and 59 patients in traditional body surface anatomy localization group. The catheterization time, catheterization success rate, number of wrong arteries, local hematoma and pneumothorax of the two groups were statistically analyzed. ResultsThe time of color Doppler localization group was 5.32 minutes, the success rate of primary catheterization was 100%, the number of wrong catheterization was 0, and the local hematoma was 0. The time of traditional body surface anatomy group was 11.13 min., the success rate of primary catheterization was 74.6% (44 cases), and the success rate of secondary catheterization was 86.4% (51 cases). The success rate of secondary catheterization was once after the failure of conversion to CDFI. Local hematoma was found in 9 patients. ConclusionsBedside color Doppler ultrasound localization in critical internal jugular vein catheterization has the advantages of short time, high success rate, low complications, meeting the needs of emergency treatment, and good application effect, especially for critical patients with unclear local anatomical location. It is easier to understand and master in intern teaching and junior doctors' training and it therefore can be widely used.