彩色多普勒超声实时引导经外周静脉穿刺置入中心静脉导管的实用价值

Application value of color Doppler ultrasound in peripherally inserted central catheter under real-time guidance

目的探讨彩色多普勒超声实时引导下,经上肢静脉穿刺置入中心静脉导管的方法与临床实用价值。方法选择需要长期静脉输液、给药,采用传统穿刺置管方法无法实施或穿刺失败的患者197例,在彩色多普勒超声实时跟踪引导下,选择上肢最合适穿刺静脉,确立最佳穿刺点及穿刺角度进行穿刺置管,将静脉导管置入中心静脉内,要求导管尖端位于上腔静脉中下1/3处。结果本组197例患者穿刺成功率为100%,穿刺血管的选择:左上肢静脉95例,右上肢静脉102例;选择贵要静脉150例,肱静脉24例,头静脉14例,肘正中静脉9例;穿刺时间为20s～22min;仅有5例出现穿刺局部血肿,无神经损伤等其他并发症发生;超声对导管尖端定位的准确性达96.95%(191/197)。结论彩色多普勒超声引导经上肢静脉穿刺置入中心导管的方法安全可靠,成功率高,并发症少,可明显缩短穿刺间,具有很高的临床实用价值,值得推广应用。

Objective To explore the methods and clinical application value of color Doppler ultrasound in peripherally inserted central catheter （PICC） under real-time guidance. Methods One hundred and ninety-seven patients who needed long- term intravenous infusion, medication, and failed or could not be punctured by traditional methods were enrolled in the study. The best upper extremity vein was selected, and the best puncture point and angle for central venous catheters placement was determined under real-time guidance by color doppler ultrasound, and the catheter tip was inserted into the lower 1/3 of the superior vena eava. Results The success rate of the 197 patients was 100% （197/197）. Choice of blood vessels for puncture included ： 95 cases of left upper extremity veins, 102 cases of right upper extremity veins ; from basilic vein in 150 cases, brachial vein in 24 cases, cephalic vein in 14 cases, median cubital vein in 9 cases. Puncture time was 20 s - 22 min, only 5 cases had local hematoma with no nerve injury and other complications, the accuracy was 96.95% （ 191/197 ）. Conclusion Color Doppler ultrasound-guided PICC is save with high success rate and low complications, and it can obviously shorten the time of puncture. It has a high clinical application value, and deserves to be widely used.