右锁骨下静脉穿刺置管术改进的解剖依据和临床应用研究

The right subclavian vein catheterization being modified and its anatomic basis and clinical application

目的 为提高穿刺成功率 ,减少并发症 ,对改进右锁骨下静脉穿刺置管术的操作方法 ,进行了解剖学研究并通过临床应用加以验证。方法 2 0具成人标本 ,按改进穿刺点定位的具体操作步骤 ,解剖观察右锁骨下静脉的行程、比邻 ,测量与该静脉有关的数据 ;并用该方法共行右锁骨下静脉中心静脉置管术 2 90 0例。结果 通过解剖观测和临床应用 ,穿刺点因矮胖与消瘦的体型有明显的差异。按改进的置管术施行的临床资料 2 90 0例 ,与原操作方法 ( 5 60例 )进行比较 ,改进后的穿刺成功率为 98.9% ( 2 868例 ) ,穿刺失败率为 1.1% ( 3 2例 ) ,其中血管畸形变异 6例 ,导管误入颈静脉 12例 ,出血倾向 7例和操作技术失误 7例 ;置管时间为 ( 3 1.2± 10 .5 )min ,发生并发症0 .79% ( 2 3例 )。原来的操作方法成功率为 73 % ,并发症发生率为 6.1% ,置管时间为 ( 5 3 .2± 10 .8)min。两组之间比较差异有显著性 (P <0 .0 1) )。结论 改进的右锁骨下静脉穿刺置管术 ,可以提高穿刺成功率 ,减少并发症 。

Objective To modify the primitive procedures of the right subclvian vein catheterization for highly successful and reduce the complications.anatomic studies were conducted and clinical applications were used.Methods Anatomical observation and measurement of the right subclavian vein and its adjacent to structures were performed on 20 adult specimens according to modified procedures.And 2?900 cases of the right subclavian vein catheterization were carried out by using the modified procedure.Results The anatomical studies and clinical application showed that the puncture point different from the bodily form of fatness and thin.The clinical data revealed that the total of 2?900 cases operations were performed of which the successful rate is 98.9%(2?868 cases) and the failure one is 1.1% (32 cases),amorg which there are 6 of blood vessel abnormality,12 of misplaced into jugular vein,7 of bleeding liability and 7 of malmanipulation.The complication is 0.79%(23cases),the catheterization time is about (31.2±10.5)?minutes.560 cases of the right subclavian vein catheterization were carried out by using the tradition procedure.the results were compared with the new method and the old method.the successful rate of the old method is 73%,complication rate is 6.1%;two methods were distinct different ( P <0.01).Conclution The modified right subclavian vein catheterization was characterized by higher successful rate and less complications and the puncture point different from the bodily form of fatness and thin.