超声引导下颈内静脉置管的临床观察

Clinical evaluation of ultrasound-guided internal jugular vein catheters placement

目的观察超声引导对颈内静脉置管成功率及并发症的影响。方法选择2010年1月至2012年12月间需行颈内静脉置管进行血液透析治疗的患者366例，随机分为2组，即超声引导组与对照组。超声引导组（188例）在超声引导下行颈内静脉置管，对照组（178例）根据体表标记盲探下行颈内静脉置管，比较2组之间的穿刺成功率及并发症情况。结果超声引导组188例患者全部穿刺成功，置管成功率为100％（188／188）；对照组178例患者中有5例置管失败，置管成功率为97．1％（173／178），2组比较差异有统计学意义（P〈0．05）。其中超声引导组有181例（占96．2％）患者一针穿刺成功，对照组有95例（占53．3％）患者一针穿刺成功，2组比较差异有统计学意义（P〈0．01）。超声引导组无一例患者发生误伤动脉、血肿、假性动脉瘤及气胸，对照组有12例患者误伤动脉，5例发生血肿，1例出现假性动脉瘤，无患者发生气胸。结论超声引导可提高颈内静脉置管成功率，减少穿刺次数及并发症的发生，值得临床推广应用。

Objective To investigate the impact of ultrasound in internal jugular vein catheters insertion about the success rate and the incidence of complications. Methods From January 2010 to December 2012~366 patients undergoing internal jugular vein catheters insertion and receiving hemodi- alysis in our hospital were divided into two groups randomly. The treatment group （188 cases） was subjected to ultrasound-guided internal jugular vein catheterization, and the control group （178 cases） to the routine internal jugular vein catheterization by using landmark method. The success rate of cath- eter placement and the incidence of complications were assessed. Results The success rate of catheter placement in the treament group and control group was 100% （188/188） and 97. 1 % （173/178） re- spectively （P〈0. 05）. The success rate of internal jugular vein catheters insertion was 96. 2% （181 ca- ses） in the first attempt of the treament group, and 53. 3% （95 cases） in the control group （P〈0. 01）. No complications, such as inadvertent arterial puncture, haematoma, pseudoaneurysm and pneu- mothorax occurred in the treatment group. Arterial puncture occurred in 12 cases, haematoma in 5 ca- ses, and pseudoaneurysm in one case in the control group. Pneumothorax was not observed in the con- trol group. Conclusions Ultrasound guidance could been utilized in the placement of linternal jugular vein catheter to improve the success rate, and minimize the times of insertion and the incidence of com- plications.