中心静脉导管准确定位在坐位神经外科手术中的应用

Accurate Placement of Central Venous Catheters in Sitting Position Neurosurgical Operation

目的利用心内心电图引导中心静脉导管准确定位,观察坐位手术中吸除气体栓子的效果。方法13例坐位手术患者,利用中心静脉导管导引钢丝作为心内电极,拾取心内心电信号,通过观察心电图波形判断导管尖端的位置,与手术后X线胸片比较,对比特异度。监测到气体栓子时抽吸中心静脉导管,观察有无气体以及气体的量。结果利用心电图原理放置导管的准确率与手术后胸片对照特异度为100%;13例中有7例监测到气体栓子,气体抽吸的成功率为100%,抽吸到的气体量0.5-20mL。结论利用心电图波形引导可准确定位中心静脉导管尖端位置,并能有效吸除栓塞气体。

Objective To place the central venous catheters accurately guided by the intracardic electrocardiography （ECG） and investigate the effects of aspirating air embolus in sitting position neurosurgical operation. Methods Thirteen sitting operation patients who received a central venous catheter to aspirate air embolus were enrolled. The central venous catheter was accurately placed by using guiding wire as internal electrode to record intracardiac signals. The position of the catheter was assessed through the changes in intracardiac ECG and re-checked with X-rays after operation. When air embolus was detected, it was aspirated through the central venous catheter and the volume of air calculated. Results The technique of using intracardiac ECG to guide the placement of central venous catheter was accurate. Seven air emboli were detected in 13 patients. The success rate of aspiration was 100% and the volumes of aspirated air were from 0.5 - 20 mL. Conclusion The technique of using intracardiac ECG guidance to detect central venous catheter tip is convenient and accurate; Air embolus can be aspirated effectively.