非经典体位下超声引导颈内静脉困难穿刺的临床应用价值

Application of Ultrasound-Guided Internal Jugular Vein Catheterization in a Non-Classical Position

目的:探讨非经典体位下超声引导颈内静脉困难穿刺的临床应用价值。方法:回顾性分析武汉大学人民医院2010-2012年非经典体位(非Trendelenberg体位)颈内静脉困难穿刺患者40例,除5例不能平卧患者直接行超声引导穿刺,35例患者行常规穿刺(A组,n=35)。常规穿刺失败行超声引导穿刺者28例(B组,n=33)。比较两组穿刺成功率(一次成功率和总成功率)、穿刺次数、并发症率(误穿动脉)、穿刺所花费时间。两种体位下颈内静脉与颈总动脉毗邻关系的百分比及比较。结果:A组7例直接穿刺成功,13例误穿颈总动脉,其余15例穿刺失败,28例均改用超声引导穿刺。B组穿刺成功30例,3例失败。A组一次成功率5.7%,总成功率20.0%,穿刺次数4.1±1.7,并发症率37.1%,B组一次成功率63.6%,总成功率90.9%,穿刺次数1.3±0.4,并发症率3.0%(P<0.05或P<0.01)。A组颈内静脉位于颈总动脉前外侧的患者(45.7%)显著高于B组(15.2%)。A组颈内静脉位于颈总动脉前的患者(25.7%)显著低于B组(42.4%)。结论:对于非经典体位下颈内静脉困难穿刺患者,超声引导穿刺优势明显,可降低操作难度,提高成功率,降低并发症。

Objective：To explore the clinical application value of ultrasound-guided internal jugular vein catheterization in a non-classical position.Methods：We retrospectively reviewed the clinical data of 40 cases in our institution from 2010 to 2012.All patients underwent internal jugular vein catheterization in a non-classical position.35 cases were cannulated using the traditional method of anatomic landmarks（Group A）,and 33cases＇ cannulation was guided using an ultrasound imaging（Group B）.The success rate,numbers of cannulation attempts,puncture time,and complication were recorded.The relationship of the internal jugular vein to the common carotid artery was compared between the two kinds of position.Results：The cannulation success rate at first attempt in group A and group B was 5.7% and 63.6%,respectively（P〈0.01）,and the total success rate was 20.0% and 90.9%,respectively（P〈0.01）.The number of attempts were less in group B than that in group A（P〈0.05）.And the incidence of complication was 37.1% ingroup A and 3.0%in group B（P〈0.01）.45.7% patients in group A showed internal jugular vein located in anterolateral common carotid artery,which is more than that in group B（15.2%,P〈0.05）.25.7% patients in group A showed internal jugular vein located in anterior of common carotid artery,which is more than that in group B（42.4%,P〈0.05）.Conclusion：Ultrasoundguided internal jugular vein catheterization in non-classical position is superior to the landmarks technique in terms of success rate,and could decrease incidence of complication.