彩色多普勒超声引导对尿毒症患者右颈内静脉穿刺置管术的监控作用

Color Doppler ultrasound- guided technique for puncture of right internal jugularvein in uremic patients

目的研究彩色多普勒超声引导直视下对尿毒症患者行右颈内静脉穿刺置管的监测效果。方法尿毒症患者64例,随机分为彩超定位组和对照组,每组32例。彩超定位组在彩色多普勒超声引导定位后穿刺,对照组采用体表标志定位穿刺,分别记录首次穿刺成功率,穿刺次数及操作时间,并发症,穿刺置管成功后定期监控。结果彩超定位组首次穿刺的成功率,穿刺次数,操作时间均明显优于对照组（P〈0.05）。通过术后定期监控,可了解导管位置是否保持准确及有无血栓形成等并发症发生。结论采用彩色多普勒超声引导直视下行颈内静脉穿刺定位准确,成功率高,操作时简便而且安全,且术后可定期监控。

Objective To improve the successful rates and security of the puncture of internal jugular vein in uremic patients, the color Doppler ultrasound- guided technique was applied and compared with traditional puncture method. Methods Sixty- four uremic patients were randomized into ultrasound group （group B） and the anatomical landmarks group（group T）, 32 patients in each group. In group B, cannulation was performed by using ultrasound scanner. The patients internal jugular veins were cannulated by using the anatomical method to palpate the carotid pulsation and identify the other anatomical landmarks. The first attempt success rate, number of attempts and cannulation time were recorded to compare between the two groups, and the following blood flow in the vessel after canulation, the thrombus or embolism and the location of floating tubes were monitored regularly. Results Compared with group T, the first attempt success rate of venous cannulation was higher, the number of attempts was less, and the cannulation time was shorter in group B （ P 〈 0.05）. The situation of floating tubes and complications are known by postoperatively monitoring periodically. Conclusion Ultrasound localization of the right internal jugular vein could significantly increase cannulation success rate, shorten the number of attempts and cannulation time. The technique was helpful and convenient for clinic service.