超声诊断性定位引导右侧颈内静脉穿刺置管的临床观察

目的:评价超声诊断性定位引导右侧颈内静脉穿刺置管的临床实用性和安全性。方法:需择期手术在超声定位引导下行右侧颈内静脉穿刺置管的患者204例,按随机数字表法,分为常规体表标志定位组(A组)及超声诊断性定位引导长轴面组(B组)、长短轴面组(C组)、短轴面组(D组),各51例,观察记录穿刺情况。结果:首次穿刺成功率A组与B、C、D组差异有统计学意义(P<0.01),B、C、D 3组差异无统计学意义(P>0.05)。A组穿刺情况均明显劣于B、C、D组(P<0.01)。B、C、D组试探次数和穿刺点数量差异均无统计学意义(P>0.05);B、C组调节方向次数、总穿刺时间和技术难度评分均小于D组(P<0.05~P<0.01),B、C组差异无统计学意义(P>0.05);4组患者刺破血管后壁发生率差异有统计学意义(P<0.01)。结论:超声诊断性定位引导右侧颈内静脉穿刺置管安全简便,成功率高,其中长短轴面穿刺法兼具长、短轴面优点,提升了成功率、有效性和安全性,值得临床推广。

Clinical evaluation of the right internal jugular vein puncture and catherization guided by ultrasound diagnostic location

Objective:To evaluate the clinical value and safety of the right internal jugular vein puncture and catherization guided by ultrasound diagnostic location. Methods:Two hundred and four patients scheduled by operation with the right internal jugular vein puncture and catherization guided by ultrasound diagnostic location were divided into the conventional surface mark positioning( group A),long axial group(group B),long-short axial group(group C) and short axial group(group D) according to the random number table (51 cases each group). Puncture conditions in four groups were recorded. Results:The differences of the puncture success rates between four groups were statistically significant(P<0. 01),the differences of the puncture success rates between A,B and C groups were not statistical significance(P>0. 05). The puncture condition in A group was worse than that in B,C and D group,the differences of which were statistically significant(P<0. 05 to P<0. 01). The differences of test times and number of puncture site between B,C and D group were not statistically significant(P >0. 05). The differences of adjusting direction times,puncture time and technical difficulty score between B,C and D group were statistical significance(P<0. 05 to P<0. 01),but in B and C groups,the difference of which was not statistically significant(P>0. 05). The incidences of complications in group B and C were lower than that in group A (P<0. 05),while the difference of which between A and D group was not statistically significant(P>0. 05). Conclusions:The right internal jugular vein puncture and catherization guided by ultrasound diagnostic location is safe, high successful rate. The long-short axial puncture method has the advantages of both long and short axis,which can improve the successful rate,efficacy and safety,and is worthy of clinical promotion.