超声体表定位用于颈内静脉中路穿刺置管的实用性观察

Application of Ultrasonic Surface Location for Internal Jugular Vein Catheterization via Central Approach

目的通过比较超声定位、引导和解剖标志定位右颈内静脉穿刺置管的成功率和并发症,阐述超声体表定位应用于颈内静脉穿刺置管的临床意义。方法择期手术患者150例,美国麻醉师协会分级Ⅰ～Ⅲ级,计算机随机号码表随机化分为解剖标志组、超声体表定位组和超声引导组,每组50例。全麻气管内插管后行右侧颈内静脉穿刺置管,解剖标志组采用体表解剖标志定位中路法穿刺,超声体表定位组和超声引导组分别在B超体表定位和引导下行颈内静脉中路穿刺。记录颈内静脉与颈总动脉的关系、穿刺针入静脉位置、穿刺成功率、穿刺点更换次数及并发症。结果超声扫查显示右侧颈内静脉与颈总动脉的关系可分为:并行、部分重叠、完全重叠3种,其中并行关系占12.7%、部分重叠占69.3%、完全重叠占18.0%;颈内静脉"安全穿刺范围"平均为(1.15±0.47)cm;超声体表定位组和超声引导组一针穿刺成功率分别为78.0%和82.0%,明显大于解剖标志组的22.0%(P<0.05);而并发症解剖标志组(12.0%)明显高于超声体表定位组(0)和超声引导组(0)(P<0.05)。结论超声体表定位可通过声像图了解穿刺横截面内动、静脉的内径、关系及走向,及早发现变异,避免穿刺的盲目性,是一种必要、可行的颈内静脉穿刺置管的辅助手段,因其操作简便、无需他人配合,更适合应用于临床工作。

Objective To explore the clinical value of ultrasonic surface localization in internal jugular vein catheterization.Methods Totally 150 patients with American Society of Anesthesiologists physical status Ⅰ-Ⅲ who were planning to receive elective surgeries were randomized into anatomical landmark group,ultrasonic surface positioning group,and ultrasound-guided group using computed random table,with 50 cases in each group.The right internal jugular vein catheterization was performed after tracheal intubation.In the anatomic landmark group,patients were punctured using surface marks through central approach.In ultrasonic surface positioning group and ultrasound-guided group,patients were punctured with ultrasonic localization and guidance through central approach.The relationship between internal jugular vein and carotid artery,the position of the needle into the vein,the success rate of puncture,the change times of puncture point,and the complications were recorded.Results Ultrasound scan revealed that the relationship between the right internal jugular vein and the right common carotid artery could be divided into three types： parallel（12.7%）,partial overlapping（69.3%）,and complete overlapping（18.0%）.The average ＂safety distance＂ of jugular vein puncture was（1.15±0.47） cm.The success rate of the first puncture attempt in ultrasonic surface positioning group and ultrasound-guided group were 78.0% and 82.0%,respectively,which was significantly higher than that in anatomic landmark group（22.0%）（P〈0.05）,whereas the complication incidence in anatomic landmark group（12.0%） were significantly higher than those in ultrasonic surface positioning group（0） and ultrasound-guided group（0）（P〈0.05）.Conclusions Ultrasonic surface positioning applied during internal jugular vein catheterization is helpful to reveal the inner diameters as well as the origin and course of arteries and veins in the puncture and identify the abnormalities as early as possible.As a simple support technique for internal jugular vein puncture,it is suitable for clinical application.