小儿低位右颈内静脉套针直接穿刺的临床观察

Clinical observation of direct puncture into pediatric right internal jugular veins with cannula needle through low approach

目的：寻求小儿经皮颈内静脉穿刺置管的捷径。方法：选１０岁以下患儿１００例，平均年龄（６．２±２．１）岁，随机分为两组（ｎ＝５０），Ⅰ组（实验组）用１８号短套针直接低位右颈内静脉穿刺置管，Ⅱ组（对照组）用传统高位穿插导引置管。结果：首次穿刺置管成功Ⅰ组４９例（占９８％）、Ⅱ组４０例（占８０％），两组比较有极显著性差异（Ｐ＜０．０１）；误穿动脉Ⅰ组１例（占２％），Ⅱ组６例（占１２％），两组比较也有显著性差异（Ｐ＜０．０５）；Ⅱ组４例首次穿刺未见回血。结论：低位右颈内静脉直接套针穿刺成功率高于传统的高位穿刺导引置管法，且并发症少。

Objective:To search for the best way of puncture and catheter insertion into the pediatric percutaneous internal jugular veins(IJV).Methods:One hundred pediatric patients under ten years old(6.2±2.1) were randomly divided into two groups,each having fifty ones.For experimental group (Group Ⅰ) 18# cannula needle was used to make direct puncture and catheter insertion into right IJV through a “low approach” and for control group(Group Ⅱ),the right IJV puncture was made through a “high approach”and the catheters were inserted by a steel wire.Results:Forty nine patients(98%)who succeeded in first IJV puncturing and catheter inserting were found in Group Ⅰ while forty (80%) in Group Ⅱ.There are extremely significant differences between the two groups( P <0.01);Carotid artery mis puncture happened to only one patient in Group Ⅰ while there were six in Group Ⅱ and there were also significant differences ( P <0.05);Four patients in Group Ⅱ were found no blood reflux at first puncture.Conclusion:Direct puncture with cannula needle into the right IJV through a “low approach”(Group Ⅰ)is more successful then through a “high approach” and produces less complications,thus being more applicable to the puncture and catheter insertion into the percutaneous IJV for patients under ten years old.