锁骨下静脉穿刺置管术600例临床观察及解剖学基础

Clinical observation and anatomical basis study on subclavian vein catheterization in 600 cases

目的熟悉锁骨下静脉的局部解剖结构,熟练掌握SVC的操作方法和技能,提高穿刺成功率。方法回顾性分析我院2010年3月至2014年3月接受SVC的600例住院患者(男410例,女190例)的临床资料。结果成功穿刺582例,穿刺成功率为97%。其中1次穿刺成功546例(91%),重复穿刺或改颈内静脉或其它穿刺38例(6.3%),失败16例(2.7%)。发生并发症22例(3.7%),其中误入动脉8例(1.3%),气胸3例(0.5%),导管尖端导入颈内静脉5例(0.8%),导管相关感染2例(0.3%),导管堵塞2例(0.3%),心律失常2例(0.3%)。结论 SVC简单易学,安全可靠,成功率高,并发症少,导管保留时间较长,是一种较好的中心静脉穿刺方法,值得在临床推广使用。

Objective To study the local anatomic structure of subclavian vein and have a good command of operating methods and skills on subclavian vein catheterization （SVC） so as to improve the success rate of puncture. Methods Retrospectively analyze the clinical data of 600 cases of hospitalized patients who have had SVC （male 410, female 190） in our hospital from March 2010 to March 2014. Results There were 582 cases （97%） of successful puncture,including 546 cases （91%） of one-time puncture success,38 cases （6. 3%） of repeated puncture or other types of puncture,and 16 cases （2. 7%） of failed puncture. Postoperative complications occurred in 22 patients （3. 7%）,including 8 cases （1. 3%） of strayed into the artery,3 cases （0. 5%） of pneumothorax,5 cases （0. 8%） of catheter tip into the internal jugular vein,2 cases （0. 3%） of catheter related infection,2 cases （0. 3%） of catheter blockage,and 2 cases （0. 3%） of arrhythmia. Conclusion SVC is easy,safe and reliable,and it is of high success rate and less complications. Catheter retention time of SVC is longer. From the above,SVC is a good central venous puncture method which is worth of popularizing in clinical use.