婴幼儿经皮颈内静脉穿刺置管的临床体会

Clinic experiences of percutaneous catheterization of the internal jugular vein for 100 cases infants and children

目的为婴幼儿心血管手术围麻醉期探索一种有效、安全、简便的经皮颈内静脉置管的方法。方法对100例实施心脏手术的婴幼儿采用低位-中央或高位-中央穿刺入路,并辅以显露颈肩部、套管针引导等措施进行右侧颈内静脉穿刺置管。结果(1)低位-中央入路58例,高位-中央入路42例,一次穿刺成功率达82%。其中,低位-中央入路一次穿刺成功率达86.20%,高位-中央入路一次成功率76.19%;(2)一次穿刺成功的50例低位-中央入路进针的平均深度为(0.62±0.24)mm,32例高位-中央入路平均进针深度(0.86±0.58)mm;(3)全组病例置入钢丝顺利,一次顺利置入导管成功率达95%;(4)高位-中央入路6例误穿入动脉;低位-中央入路2例误穿入动脉,1例发生气胸,1例发生纵隔血肿。结论合适的体位、准确的定位和入路,采用套管针引导的方法是提高婴幼儿经皮颈内静脉穿刺置管成功率的关键。

Objective To seek one of simple, safe and convenient method Percutancous catheterization of the internal jugular vein for infants and children who carried on cardiovascular operation during anesthesia. Methods 100 cases infants and children who carried on cardiac operation, were used two enter way of puncture：hlgh-central enter way or low- central enter way, and adopted measure d neck shoulder appeared and venous trocar lead to carry on fight intemal jugular venous puncture and catheterization. Results （1）Low- central enter way were sommed to 58 cases, high - central enter way were surmed to 42 eases, one puncture rate of success was up to 82 %. Among them, low - central enter way was 86.2%, high - central enter way was 76.19%. （2）One puncture successful 50 cases of low- central enter way entered average depth of stitch 0.62 ± 0.24mm, 32 cases high - central enter way entered average depth of stitch 0.86 ± 0.58mm. （3）The whole cases put into steel wire smcothly, and success rate of one place venous catheter reached to 95 %. （4）In the high - central enter way, there were six cases happened artery penetrated. In the high - central enter way, there were two cases happened artery penetrated, one case happened pneumothorax, one case happened rnediastinal hematoma. Conclusion The methods of Suitable body posture, accurate localization and enter way of puncture, as well as adopting venous trocar lead were the key to raise rate of success of percutaneous jugular puncture and catheterization for infants and children.