颈内静脉置管在肝、脾破裂救治术中的应用

INTERNAL JUGULAR VEIN INDWELLING CATHETER APPLIED IN CURING LIVER OR SPLEEN RUPTURE

目的评价颈内静脉置管应用于肝、脾破裂失血性休克手术的可行性。方法对48例肝、脾破裂大出血急诊手术麻醉配合过程进行分析,并采取针对性的抢救措施;观察记录颈内静脉总穿刺成功率、一次试穿成功率、置管成功率、穿刺成功的时间、置管完成时间及并发症。结果颈内静脉穿刺总成功率为100·0%,一次穿刺成功率为90·6%,穿刺成功的时间为(17±6)s,置插管完成时间(130±38)s,误穿动脉3例,置管困难3例,没有气胸、血胸及导管异位等并发症发生。经积极抗休克,48例病人手术成功率达到100·0%。结论颈内静脉置管应用于肝、脾破裂出血性休克手术安全、操作容易、穿刺置管成功率及一次穿成功率高,值得推广应用。

Objective To evaluate the feasibility of internal jugular vein indwelling catheter applied for liver, spleen rupture induced hemorrhage shock operation, Methods To analyze the anesthesia cooperation process of 48 cases of emergency operation for liver, spleen rapture induced large hemorrhage, and the pertinent salvage measures, Observe and record the total success rate of internal jugular vein puncture, the success rate of first puncture, the success rate of indwelling catheter, the time of succesful puncture, the time of completing indwelling catheter and the complications. Results The total success rate of internal jugular vein puncture is 100.0%, the success rate of first puncture is 90. 6%, the time of succes~.l puncture is （ 17 ±6）s, the time of completing indwelling catheter is （ 130 ±38）s,miss puncture to artery in 3 cases, difficult to indwelling catheter in 3 cases, no complication of pneumothorax, hemathorax or ectopic catheter occurred. Through active anti- shock measures, success rate of operations achieved 100.0% in 48 patients. Conclusion Internal jugular vein indwelling catheter applied for liver, spleen rupture induced hemorrhage shock is safe and feasible to operate, with high success rate of indwelling catheter and first puncture, and worthy to extend application.