特殊体位锁骨下静脉穿刺方法研究

STUDY ON THE METHOD OF SUBCLAVIAN VEIN PARACENTESIS IN A SPECIAL BODY

目的：探讨在患者因特定治疗或病情等不能平卧时，行锁骨下静脉穿刺术的方法。方法：对1999年5月-2004年5月间进行非常规锁骨下静脉穿刺操作的78例病例进行回顾性调查。按其穿刺入路分为上入路组和下入路组，结合病例特点进行分析；按目的不同分为“透析组”和“非透析组”，结合操作方法进行分析。结果：按照入路分组：行上入路锁骨下穿刺术的病例54例，行下入路锁骨穿刺术的病例24例。按照目的分组：透析组46例，非透析组32例。结论：在非常规体位和条件下行锁骨下静脉穿刺术，首先要严格掌握穿刺适应征，以减少并发症发生；其次，应根据患者的临床特点和穿刺目的选择穿刺方法：对于透析病人，由于其透析的特殊需要，全应行上入路锁骨下静脉穿刺；对于非透析病人，应根据病人体位、不同入路穿刺的特点、术野的暴露情况以及穿刺时的环境等灵活选择，以增加穿刺成功率。

Objective ： To discuss how to find a method of subclavian vein paracentesis, when patients was under definited therapy or could not lie down. Method ： 78 cases of subclavian vein Paracentesis were studed retrospectively form 1999 to 2004, all of patients were divided into two groups by different purpose, which were superior pathway and infra -pathway, and different pathways, which were dialyse group an non -dialyse. Results： According to pathways, 54 cases of subclavian vein Paracentesis were proceed to superior pathway, other were infra - pathway. At same time, according to method, 46 cases of subclavian vein Paracentesis were dialyse group, others were non - dialyse. Conclusion ： Firstly, Pubcalvian vein paracentesis under non - normal postur should be used carefully to reduce the occurrence of complication. Secondly, the method of puncture should be elected by different clinic behavior and purpose.