应用骨性标志指导右颈内静脉穿刺的临床研究

Clinical study of right internal jugular vein puncture guided by bone landmarks

目的探讨应用骨性标志指导右颈内静脉穿刺置管术的可行性与安全性。方法选择行中心静脉穿刺置管术的择期全麻成人患者114例,以右颈内静脉作为穿刺部位。采取骨性标志定位,即以右锁骨上切迹与乳突尖前方凹陷顶点做一连线,与甲状软骨水平线的交点作为穿刺点。记录穿刺的成功率、穿刺时间、并发症及麻醉医师的工作年限。结果 114例患者进针深度为(1.8±0.6)cm,穿刺时间为(3.2±1.4)min;一次穿刺置管成功率为96.5%;均无气胸、血胸、液气胸、空气栓塞、心律失常等并发症发生;仅2例误穿动脉,形成血肿,改用其他方法穿刺成功;穿刺成功率与麻醉医师的年资无显著相关性(r=0.05,P>0.05)。结论应用骨性标志指导颈内静脉穿刺,定位准确,穿刺成功率高,并发症少,大大提高了穿刺置管的成功率和效率,值得广大医生学习掌握。

Objective To assess the feasibility and safety of bone landmarks for right internal jugular vein（RIJV）puncture.Methods A total of 114 patients undergoing RIJV cannulation under general anesthesia were enrolled into the study.The right internal jugular vein was regarded as the puncture site which was positioned by bone landmarks.I.e.：We made a line between right supraclavicular notch and umbilication in front of mastoidale.The puncture site was the junction of thyroid cartilage horizontal line and the line we made.The success rate,puncture time and incidence of arterial puncture and other complications were recorded.Results The success rate of one-time catheterization was 96.5%.The puncture time was（3.2±1.4）min.None of the patients had pneumothorax,haemothorax hydropneumothorax aeroembolism and arrhythmia.Only 2 patients suffered from arterial puncture and hematomas,and were successfully punctured by other methods.There was no significant correlation between the success rate of puncture and the past service of anesthesiologists（r=0.05,P0.05）.Conclusions Bone landmarks are clear,fixed,and accurate for the location of right internal jugular vein puncture,for its high success rate,high efficiency and few complications.This paracentesis is simple,safe and easy to master,worthy of study and master by doctors.