肝移植术中心静脉穿刺置管的解剖定位研究

Clinical study of central venous catheterization using anatomic landmarks in patients undergoing liver transplantation

目的比较解剖定位颈内静脉和锁骨下静脉两种路径行中心静脉穿刺置管的成功率和并发症,为临床选择安全有效的穿刺路径提供参考。方法限期肝移植手术患者随机交叉研究,随机确定颈内静脉和锁骨下静脉穿刺的先后顺序。全身麻醉诱导后,由同一组麻醉医师依据解剖定位标志按确定的穿刺顺序完成颈内静脉穿刺置管、锁骨下静脉穿刺置管。记录成功置管前静脉穿刺次数、引导钢丝置入次数,置管时间;同时记录误入动脉、血肿形成、气胸等并发症的发生率。结果 42例限期肝移植手术患者入选该研究。颈内静脉和锁骨下静脉穿刺置管的次数分别为(2.3±0.7)次,(2.9±1.4)次(n=42,P<0.05),置管时间分别是(1.58±0.49)min,(2.24±1.01)min(n=42,P<0.05)。1例患者行颈内静脉穿刺时误入颈动脉,并发血肿;1例患者行锁骨下静脉穿刺后出现血肿。结论解剖定位穿刺颈内静脉比锁骨下静脉更容易更快捷。

Objective To compare the success rate and incidence of complications of central venous catheterization via internal jugular vein（IJV）versus subclavian vein（SCV）using anatomic landmarks,and to give suggestion for easy and safe choosing in clinic.Methods A randomized,crossover study in patients undergoing semi-selective liver transplantation were performed.After anesthesia induction,the IJV and SCV were punctured and catheterized using anatomic landmarks consecutively in a randomized crossover fashion by the same anesthesiologists.The data collected included the number of venipuncture and guidewire insertion attempts until success,the time from first venipuncture to successful guidewire insertion,and the associated complications.Results Cannulation via SCV required more attempts than via IJV（2.9±1.4 vs 2.3±0.7,n=42, P0.05）,however,cannualtion via SCV was more time comsuming than via IJV（2.24±1.01 vs 1.58±0.49 min, n=42,P0.05）.One patient developed a hematoma after accidental carotid artery puncture during the process of IJV catheterization.Arterial puncture did not occur during SCV catheterization,but a hematoma developed in one patient.Conclusions Central venous cannulation via IJV is more easier and quicker than via SCV.