超声引导下中心静脉置管在脑卒中继发胸腔积液引流中的应用

Application of ultrasound-guided central venous catheterization in drainage of pleural effusion secondary to stroke

目的 观察超声引导下中心静脉置管在脑卒中继发胸腔积液患者引流中的应用效果.方法 采用回顾性研究方法,选择2018年1月至2019年6月在武警浙江省总队医院进行治疗的120例脑卒中继发胸腔积液患者,按治疗方式不同将患者分为观察组(67例)和对照组(53例).观察组在超声引导下进行中心静脉导管置管引流;对照组在超声定位后进行中心静脉导管置管引流.观察两组患者一次性穿刺置管成功率、导管留置时间及引流量;并比较两组患者临床疗效、症状改善时间、住院时间及并发症发生率.结果 观察组一次性穿刺置管成功率、引流量、呼吸困难改善持续时间及临床总有效率均明显高于对照组[一次性穿刺置管成功率:100.00%(67/67)比92.45%(49/53),引流量(mL):2 148.19±314.26比1 938.37±257.93,呼吸困难改善持续时间(d):5.28±0.78比2.62±0.43,总有效率:89.55%(60/67)比75.47% (40/53),均P<0.05].两组患者引流量变化图显示,观察组引流量曲线下降陡直,对照组患者引流量曲线下降相对平缓,每大引流量的变化相对较小.观察组导管留置时间、胸腔积液消退时间、住院时间和并发症发生率均明显低于对照组[导管留置时间(d):5.49±1.27比6.22±1.79,胸腔积液消退时间(d):6.15±0.97比9.29±1.34,住院时间(d):10.28±2.31比13.55±2.84,并发症发生率:5.97%(4/67)比18.87%(10/53),均P<0.05].结论 超声引导下中心静脉置管应用于脑卒中继发胸腔积液引流能明显提高一次性穿刺置管成功率,显著改善引流效果;同时还能有效减少相关并发症的发生,值得临床上积极推广.

Objective To observe the effect of ultrasound-guided central venous catheterization in the drainage of patients with pleural effusion secondary to stroke.Methods A retrospective method was conducted,stotally 120 patients with pleural effusion secondary to stroke treated in Zhejiang Provincial General Hospital of Armed Police from January 2018 to June 2019 were selected and divided into observation group(67 cases)and control group(53 cases)according to diagnosis and treatment methods.In the observation group,catheter drainage was performed under the guidance of ultrasound;in the control group,catheter drainage was performed after ultrasound localization.The success rate of one-time catheter puncture,catheter retention time and drainage volume in two groups were observed,and the clinical efficacy,symptom improvement time,hospital stay and incidence of complication were compared between the two groups.Results The success rate of one-time catheter puncture,drainage volume,duration of dyspnea improvement and total clinical effective rate of the observation group were significantly higher than those of the control group[success rate of one-time catheter puncture:100.00%(67/67)vs.92.45%(49/53),drainage volume(mL):2148.19±314.26 vs.1938.37±257.93,duration of dyspnea improvement(d):5.28±0.78 vs.2.62±0.43,total effective rate:89.55%:(60/67)vs.75.47%(40/53),all P<0.05].The drainage chart of two groups showed that the drainage curve of observation group decreased steeply and straightly,the drainage curve of control group decreased relatively gently,and the change of daily drainage volume was relatively small.The time of catheter retention,time of pleural effusion regression,hospital stay and incidence of complications in observation group were significantly lower than those in control group[catheter retention time(days):5.49±1.27 vs.6.22±1.79,pleural effusion regression time(days):6.15±0.97 vs.9.29±1.34,hospital stay(days):10.28±2.31 vs.13.55±2.84,incidence of complications:5.97%(4/67)vs.18.87%(10/53),all P<0.05].Conclusion The application of ultrasound-guided central venous catheterization in the drainage of pleural effusion secondary to stroke can significantly improve the success rate of one-time puncture and significantly improve the drainage effect;at the same time,it can effectively reduce the incidence of related complications,which is worthy of active promotion in clinical practice.