中心静脉穿刺置管380例临床分析

Clinical analysis of central venipuncture and catheterization:380 cases analysis

目的:探讨在手术及临床治疗中中心静脉穿刺置管的应用状况。方法:回顾性分析我院近3年来有详细记录的各类中心静脉穿刺置管380例临床资料,分析不同病种、不同入路行中心静脉穿刺置管的成功率及并发症情况。结果:手术室病人心血管手术及急、危重大手术颈内穿刺1次成功率分别为76.0%、78.4%,锁骨下穿刺1次成功率分别为100.0%、75.0%;手术室病人中行中心静脉置管误刺动脉19例(6.48%),血肿3例(1.02%)。临床科室病人中急、危重病人及输液困难病人颈内穿刺1次成功率分别为58.3%、70.7%,锁骨下穿刺1次成功率分别为100.0%、75.0%,临床科室病人行中心静脉置管误刺动脉5例(5.74%)。结论:中心静脉穿刺可在不同的医疗环境内进行,熟悉解剖学知识,按解剖关系准确定位,选择正确的穿刺部位和规范的技术操作是提高穿刺成功率和减少穿刺并发症的关键,严格的无菌操作和护理质量的提高能减少感染的发生率。

Objective： To explore the application of central venipueture and catheterization in clinical treatment and surgery. Methods： Retrospectively analyzed clinical datas of 380 cases treated with venipueture and catheterization during recent 3years, and compared success rate and complication incidence of different diseases en- tity and surgery approach. Results： One-time success rates of internal jugular vein puncture for surgery patients including patients with cardiovascular surgery, and emergency, critical surgery or major surgery were 76% and 78.4% respectively; while one-time success rates of subclavian vein puncture were 100% and 75% respectively. 19 surgery patients＇arteries were pricked by accidence （6.48%）, while three patients had hematoma （1.02%）. In clinical department, one-time success rates of internal jugular vein puncture for emergency or critical patients and patiqnts with difficult transfusion were 58.3% and 70.7% respectively, while one-time success rates of subclavian vein puncture were 100% and 75% respectively ; 5 patients arteries were pricked by accidence （5.74%）. Conclusion： Central venipucture and catheterization can be applied under various medical environments. Anatomy knowledge, exact location, accurate puncture point and regular operation can boost the success puncture rate and decline complication incidence. Strict aseptic technique and high-quality nursing can decrease the infectious incidence.