改良式颈外 腋及股静脉置管在危重新生儿急救中的应用

Application of modified lateral cervical, axillary,femoral venous catheter to the seriously injured newborn

目的探讨危重新生儿颈外、腋及股静脉置管的应用解剖，总结出颈外、腋及股静脉置管的改良式解剖定位法，并观察其应用效果。方法实体观察死亡新生儿颈外、腋及股静脉位置、走向、血管毗邻组织等，总结出改良式解剖定位法，结合实际工作，将180例危重新生儿随机分为试验组（改良式解剖定位法）和对照组，两组各行颈外、腋及股静脉置管30例。对两组一次成功置管平均时间、留置时间和一次置管成功率等情况进行比较。结果通过实体观察死亡新生儿颈外、腋及股静脉位置、走向、血管毗邻组织等，总结出新生儿颈外、腋及股静脉置管改良式解剖定位法，试验组一次成功置管平均时间为（72．8±16．1）s，对照组（305．9±118．9）S，两组比较差异有统计学意义（P〈0．01）；试验组留置时间（149．8±13．6）h，对照组（78．5±13．2）h，两组比较差异有统计学意义（P〈0．01）；试验组一次置管成功率87．78％，对照组74．44％，两组比较差异有统计学意义（P〈0．05）。结论通过实体观察死亡新生儿颈外、腋及股静脉位置、走向、血管毗邻组织等，把解剖经验及体会用于临床，总结出新生儿颈外、腋及股静脉置管改良式解剖定位法是安全可行的，不仅提高了工作效率，更重要的是可明显减少危重新生儿置管次数，减少患儿的痛苦和感染的几率，提高抢救质量和抢救成功率，值得临床推广应用。

Objective To discuss modified dissection location through lateral cervical, axillary, femoral venous catheter in the seriously injured newborn and to observe the curative effect. Methods To observe dead newborn neck, armpit, and femoral vein position, the trend, the organization adjacent to the blood vessel and so on, and to summarize modified dissection location. 180 critically injured newborns were randomly divided into the experimental group （modified dissection location） and the conventional group. 30 cases in each group accepted lateral cervical, axillary, femoral venous catheter. The mean time of successful catheter, retention time, successful ratio of intubation were compared in two groups. Results The mean time of successful catheter was （ 72. 8± 16. 1 ） seconds in experimental group, and （ 305.9 ± 118.9 ） seconds in the control group （ P 〈 0. 01 ） ; retention time was （ 149.8 ± 13.6 ） h in experimental group, and （78.5 ± 13.2 ） h in control group （ P 〈 0.01 ） ; successful ratio of intubation was 87. 78% in the experimental group, and 74. 44% in control group （P 〈 0.05）. Conclusion Modified dissection location is safe, and not only improve the working efficiency and rescue success ratio, but also reduce the times of catheter in critically injured newborn, baby＇s pains and the infection probability.