超声引导与颈总动脉搏动旁右颈内静脉穿刺法在右颈内静脉穿刺置管术的应用比较

Comparison of ultrasound guide and carotid artery pulsation right internal jugular vein puncture on right internal jugular vein catheterization

目的超声引导右颈内静脉穿刺法与颈总动脉搏动旁右颈内静脉穿刺法在右颈内静脉穿刺置管术的应用价值。方法选择2010年9月～2014年5月于连云港市第一人民医院择期手术患者,术前评估需行右颈内静脉穿刺置管术,共120例,随机分成超声引导组（采用超声引导下右颈内静脉穿刺置管术,60例）和颈总动脉搏动旁组（采用右颈总动脉搏动旁右颈内静脉穿刺置管术,60例）。记录并分析两种穿刺方法从消毒开始至顺利置入中心静脉导管所需要的穿刺次数、穿刺时间、穿刺成功率及并发症情况。结果超声引导组首次穿刺成功53例（88.3%）,对照组首次穿刺成功44例（73.3%）,差异有统计学意义（P〈0.05）;但两组间总成功率比较,差异无统计学意义（P〉0.05）。超声引导组的平均穿刺时间为（3.9±1.6）min,明显短于对照组的（7.8±1.9）min,差异有高度统计学意义（P〈0.01）。超声引导组无并发症发生,对照组有6例（10%）发生并发症。结论超声引导法首次穿刺成功率优于颈总动脉搏动旁法,穿刺时间明显缩短,并可有效避免并发症发生,可见超声引导下右颈内静脉穿刺置管快速、安全、有效,值得临床推广应用。

Objective To compare ultrasound guide and carotid artery pulsation right internal jugular vein puncture on right internal jugular vein catheterization. Methods From September 2010 to May 2014, in the First People＇s Hospital of Lianyungang City, 120 patients with scheduled surgery, and needed right internal jugular vein puncture before the surgery seleted were randomly divided into ultrasound group （given right internal jugular vein puncture guided by ultra- sound, 60 cases） and carotid artery pulsation group （given right internal jugular vein puncture beside the right carotid artery, 60 cases）. The times and time of puncture from the disinfection to central venous catheter placement, success rate and complications in two groups were recorded and compared. Results The one the successful puncture in ultra- sound group was 53 cases （88.3%）, while the carotid artery pulsation group was 44 cases （73.3%）, the differences between the two groups was statistical significance （P 〈 0.05）, but there was no statistically significant difference of the total success rate （P 〉 0.05）. The puncture time in ultrasound group was （3.9±1.6） rain, shorter than that in control group [（7.8± 1.9） min], the difference was statistically significant （P 〈 0.01）. There was no complications happened in ultrasound group, while 6 cases （10%） happened complications in control group. Conclusion The first successful puncture rate guided by ultrasound is superior to the common carotid artery pulse method with shorter puncture time and lower com- plications. Ultrasound guide right internal jugular vein puncture is a fast, safe, effective method and worthy of clinical application.