两种深静脉置管术在ICU临床应用观察

Clinical observation of two deep vein catheterizations in ICU

目的观察锁骨下和股静脉较两种深静脉置管术的难易程度及其主要的并发症。方法选择ICU内需做深静脉置管的患者300例,随机分为锁骨下静脉(A组)150例,股静脉(B组)150例,通过比较2组的穿刺的成功率及其主要并发症等指标,从而明确两个部位穿刺的优缺点。结果股静脉穿刺组成功率高,与锁骨下静脉组比较差异有显著性(P<0.05)。锁骨下置管并发导管移位、气胸最高(P<0.05),而股静脉置管并发误入动脉,感染,及堵管较高(P<0.05)。导管脱出并发症两者无显著性差异(P>0.05)。结论 2种置管方法各有其优缺点,操作者可以根据置管的目的,患者情况以及个人对两种置管术操作的熟练程度,合理选择置管方法,减少置管出现的并发症的可能。

Objective To observe the difficulties and main complications in clinical application of subclavian venous cath- eterization and femoral venous catheterization. Methods 300 ICU patients who needed to be treated with domestic deep ve- nous catheter,were randomly divided into a subclavian vein group （group A, 150 cases ） , and a femoral vein group（group B, 150 eases ） , and the success rate, major complications and other indicators were compared so as to evaluate the advantages and disadvantages of the two punctures. Results The success rate of femoral vein puncture was higher. The difference was signifi- cant（ P 〈 0.05）. Subclavian catheterization was highly complicated by catheter displacement and pneumothorax （P 〈 0.05） , while the incidence of the femoral vein catheter concurrent strayed artery,infection, and pipe blocking was higher（ P 〈 0. 05 ）. Prolapsed catheter complications had no significant differences between the two groups （ P 〉 0. 05 ] ~ Conclusion Both methods have their advantages and disadvantages. The operator can choose the better method according to the purpose of the tube, the patient＇s condition and personal proficiency to reduce possible catheter complications. It is necessary to be familiar with the a- natomy of the catheter tube and summarize accumulated lessons to ensure the success of catheterization.