B超定位下深静脉置管术在血液透析中的临床应用

B Ultrasound Positioning Under Deep Venipuncture Technique in Clinical Application of Hemodialysis

目的:探讨血液透析治疗中行B超定位下行深静脉置管术的临床应用。方法:回顾性分析广东省中医院血液透析科近两年来280例需深静脉置管术,统计使用盲穿及B超定位两种方法下穿刺颈内静脉股静脉的例数、一次性成功率、总成功率、并发症发生种类及例数等。比较两组患者的置管成功率及插管并发症发生率。结果:280例中颈内静脉置管术210例,股静脉置管术70例;常规盲穿218例,其中一次成功163例(74.7%),总成功率180例(82.6%)发生局部血肿12例(5.5%),误穿动脉10例(4.5%),皮下气肿1例(0.4%),动脉瘤1例(0.4%);B超定位组62例,其中一次成功57例(91.9%),总成功率59例(95.1%)发生血肿2例(3.2%),未发生其他并发症;与常规盲穿比较,超声定位的一次成功率及总成功率均明显提高(P<0.05),近期并发症的发生率明显降低。结论:与传统盲穿深静脉置管术相比,该技术具有穿刺成功率高、并发症少、损伤小、安全有效等优点。

Objective： To investigate the treatment of hemodialysis in ultrasound localization by central ve- nous catheterization application. Methods： 280 cases of central venous catheterization in recent 2 years were retro- spe ctively analyze. Different catheterization methods were adopted, including blind intubation and ultrasound lo- catization in internal jugular vein, femoral vein. Complications and the rate of successful catheterization were al- so evaluated. Results： Central vein catheterization was performed for a total of 280 cases, including 210 cases of internal jugular vein, 70 cases of femoral vein. Of the blind intubation 218 cases, successful cases in 163 cases （74.7%）, the total success rate 180 cases （82.6%） local hematoma in 12 cases （5.5%）, arterial puncture oc- curred in 10 cases （4.5%） ; subcutaneous emphysema in i cases （0.4%）, aneurysm in I cases （0.4%）. Of the ultrasound locatization 62 cases, successful cases in 57 cases （91.9 % ）, the total success rate 59 cases （95.1% ）, local hematoma in 22 cases （3.2%）, none of other complication. In comparison with the conventional blind, a success rate of ultrasonic location and the total success rate were significantly improved （P〈 0.05）, significantly reduced the incidence of complications. Conclusion：With the traditional blind in deep vein catheterization com- pared, this technology has high successful puncture rate, fewer complications, less injury, safe and effective.