超声中线定位方法用于颈内静脉穿刺置管术的临床研究

Cinical studies of ultrasonic midline location for internal jugular vein catheterization via transverse approach

目的比较两种超声定位方法与解剖定位方法行右颈内静脉(rIJV)穿刺置管的临床效果。方法择期手术患者120例,随机分为三组:解剖定位(AL)组,超声中线预定位(PU)组,超声中线实时定位(RU)组,每组40例。全麻气管插管后行rIJV穿刺置管,记录穿刺针入静脉的位置,穿刺、置管时间,穿刺次数,成功率及并发症。结果与AL组比较,PU组和RU组穿刺点距静脉中点距离明显缩短(P<0.01),穿刺、置管时间明显减少(P<0.01),穿刺次数明显减少(P<0.01),静脉后壁穿透率明显降低(P<0.05),一次成功率明显升高(P<0.05)。AL组3例误穿动脉,2例血肿,PU组、RU组仅有1例误穿动脉。结论在行IJV穿刺置管过程中超声中线定位比解剖定位具有明显优势,且超声中线预定位和超声中线实时定位同样有效。

Objective To compare both the ultrasound-guided technique with the classical ana- tomical landmark technique （central approach） for right internal jugular vein （rIJV） catheterization. Methods One hundred and twenty patients requiring rlJV cannulation were included and were ran- domly allocated to the anatomical landmark group （group AL）, ultrasonic midline prelocation group （group PU） and ultrasonic midline real-time imaging group （group RU）. The rlJV catheterization was performed after tracheal intubation. The position of the needle into the vein, venous access time, catheterization time, number of attempts, success rate and the complications were observed. Results Group AL puncture needle into the vein was located closer to the lateral of venous than the group PU and group RU （P〈 0. 01）. The venous access time and catheterization time in the group AL was significantly longer than that in the group PU and group RU （P〈 0. 01）. Number of attempts and wall of vein penetration were both decreased in the ultrasonic midline location group com pared to the group AL （P〈 0. 05）. The success rate decreased in the group AL compared with the group PU and group RU （P〈 0.05）. Three patients in the group AL and one patient in the ultrasonic midline location group occurred artery puncture. Two patients in the group AL occurred hematoma. Conclusion Both the ultrasonic midline location techniques are found to be better than the anatomical landmark technique. Further, ultrasonic midline prelocation is as effective as ultrasonic midline realtime imaging technique for rIJV catheterization.