中心静脉通道的建立及其在临床中的应用

The clinical application of central venous access

目的 倡导建立中心静脉通道的重要性 ,比较经右锁骨下静脉 (TSCV)和右颈内静脉 (TIJV)两种途径建立中心静脉通道的技术特点。方法 自 1999年 3月至 2 0 0 1年 6月间共完成中心静脉通道植入术 348例次 ,其中经右锁骨下静脉2 70例次 ,经右侧颈内静脉 78例次 ;导管留置时间 13～ 75d ,平均 2 3d。结果 TSCV组 2 70次 ,2 6 8次成功 ,成功率 99%。操作中和留置期间 11例出现严重并发症 ,包括气胸 2例 ,误留入锁骨下动脉 1例 ,留置管阻塞 3例 ,留置管进入右颈内静脉引起输液异常 3例。穿刺口感染 2例。TIJV组 78次 75次成功 ,成功率 96 % ,严重并发症 1次。结论 中心静脉通道在临床上具有很大的实用价值 。

Objective To advocate the importance of central venous access(CVA), and compare the technical characteristics and clinical values of central venous access constructed trans right subclavian vein (TSCV) and trans the right internal jugular vein (TIJV). Methods Between March 1999 and June 2001, we operated 348 cases of CVA, including 270 TSCV and 78 TIJV. The durations of reserving the accesses were 13～75 day, average 23 days. Results In 270 TSCV, 268 cases were successful, the successful rate was 99%. 11 cases had critical complications, including: 2 cases of pneumothorax, 1 access was constructed into subclavian artery, 3 accesses obstruction, 3 accesses of anomalous transfusion caused by catheter shift, infection of puncture site 2 cases. In 78 TIJV, 75 cases were successful, the successful rate were 96%. The critical complications occurred in 1 case.Conclusions The CVA is safe, easy, and practical, which would provide the special and immediate medical therapy for the tumorous and critical patients. In emergency, the TSCV procedure would be the choice.