超声引导深静脉穿刺置管在血液透析中的应用

Application of Ultrasound Guided Deep Venous Catheterization in Patients Treated by Hemodialysis

目的:探讨超声引导深静脉穿刺置管在血液透析治疗中的应用价值。方法:将2014年5月至2015年1月需行深静脉穿刺置管的血液透析患者120例随机分为体表解剖标志组(A组)、超声定位组(B组)及超声引导组(C组),每组各40例,A组依据体表解剖标志行中路法穿刺,B组使用B超定位穿刺点和穿刺方向后穿刺,C组在超声实时引导下根据超声图像穿刺,观察记录颈总动脉与颈内静脉、股动脉与股静脉的关系及血管异位情况,比较3组之间的穿刺成功率和并发症。结果:超声探查显示颈总动脉与颈内静脉呈并行者占25.0%,呈部分重叠者占65.6%,呈完全重叠和异位者各占4.7%;股动脉与股静脉呈并行者占43.8%,部分重叠者占31.3%,完全重叠者占6.3%,异位者占18.8%。C组的穿刺成功率明显高于A组,且并发症的发生率明显低于A组(P均<0.05)。结论:超声引导穿刺置管可提高深静脉穿刺置管的安全性和成功率,降低并发症的发生。

Objective：To explore the value of ultrasound guided deep venous catheterization in hemodialysis patients. Methods：120 patients planning to receive hemodialysis were randomized into anatomical landmark group （group A,n=40）, ultrasonic localization group （group B,n=40） and ultrasound guided group （group C,n=40）.The relationship between internal jugular vein and carotid arteru,femoral vein and femoral artery,the success rate of puncture and the complications were compared among the three groups. Results：Ultrasound scan revealed that the relationships between right internal jugular vein and right carotie cateru could be divided into four types：parallel （25.0%）,partial overlapping （65.6%）,complete eoverlapping （4.7%）,angiectopia （4.7%）.The relationship between right femoral vein and right femoral artery also divided into four types： parallel（43.8%）,partial overlapping（31.3%）, complete overlapping （6.3%）,angiectopia （18.8%）. The rate of success puncture in group C was significantly higher than that in the group A,but the incidence of complications were significantly lower,both P＆lt;0.05. Conclusions：Ultrasound guided could been utilized in the placement of deep vein catheter to improve the success rate and minimize the incidence of complication.