超声引导定位对尿毒症颈内静脉穿刺置管和血液透析充分性的影响

Effect of ultrasound-guided localization on catheterization of internal jugular vein and adequacy of hemodialysis in uremia patients

目的:探讨超声引导定位在尿毒症患者颈内静脉(IJV)穿刺置管的应用效果及对血液透析充分性的影响。方法:回顾性分析106例IJV穿刺置管尿毒症患者的相关资料,按IJV置管方法不同,分成解剖定位组(n=54)和超声引导组(n=52)。比较两组穿刺置管耗时、穿刺成功率、并发症发生率和首次透析血流速、尿素氮下降率(URR)、整体尿素氮下降率(Kt/V)等指标。结果:超声引导组穿刺置管耗时短于解剖定位组(P<0.05),穿刺成功率、1次穿刺成功率高于解剖定位组(P<0.05),并发症发生率低于解剖定位组(P<0.05)。超声引导组置管后首次透析血流速、URR、Kt/V均略高于解剖定位组,但差异无统计学意义(P>0.05)。结论:超声引导定位进行IJV穿刺置管操作可提高穿刺成功率,缩短操作时间,减少穿刺并发症发生,保障血液透析的充分性,可在临床推广使用。

Objective:To investigate the application effect of ultrasound-guided positioning in internal jugular vein(IJV)puncture and catheterization in uremia patients and its influence on hemodialysis adequacy.Methods:106 cases of uremic patients with IJV puncture catheter were retrospectively analyzed.According to the different methods of IJV catheterization,they were divided into anatomical positioning group(n=54)and ultrasound-guided group(n=52).The time of catheterization,the success rate of puncture,the incidence of complications,the first dialysis blood flow rate,urea nitrogen decline rate(URR)and overall urea nitrogen decline rate(Kt/V)were compared between the two groups.Results:The time of catheterization in ultrasound-guided group was shorter than that in anatomic positioning group,and the success rate of one-time puncture and puncture was higher than that in anatomical positioning group(P<0.05).The incidence of puncture complications in ultrasound-guided group was lower than that in anatomic localization group(P<0.05).The first dialysis blood flow rate,URR and Kt/V in ultrasound-guided group were slightly higher than those in anatomical positioning group,the differences were not significant(P>0.05).Conclusion:Ultrasound guided IJV catheterization can significantly improve the success rate of puncture,shorten the operation time,reduce the incidence of puncture complications,and ensure the adequacy of hemodialysis,which can be widely used in clinic.