超声引导下深静脉穿刺置管术建立血管通路在血液透析中的应用

Ultrasound-guided deep venous catheterization in vascular access for hemodialysis

目的评价超声引导下行深静脉穿刺置管术建立血管通路在血液透析中的应用价值。方法选择本院肾科2015年透析患者200例,按就诊序号2∶1比例分为超声定位组(A组)132例和体表解剖标志定位组(B组)68例,观察两组置管成功率、第1针穿刺成功率、穿刺时间、并发症(置管后2周内感染情况、血肿、误穿动脉)。采用SPSS 16.0统计软件进行分析。结果两组置管成功率均是100%,差异无统计学意义(P>0.05);A组颈内静脉和股静脉第1针穿刺成功率分别为96.0%和93.3%,高于B组70.0%和62.5%;A组颈内静脉和股静脉穿刺平均时间分别为(7.15±2.59)min和(7.43±3.29)min,与B组的(11.24±6.49)min和(12.80±5.78)min比较,A组明显少于B组(P<0.05);并发症(血肿)A组1例(0.7%),明显少于B组并发症(血肿、误穿动脉)4例(5.8%);置管2周内感染率A组3例(2.2%)低于B组5例(7.3%)。结论在超声引导下行深静脉穿刺置管术可以提高第一针穿刺成功率,减少穿刺操作时间,减少并发症,值得在血液透析深静脉置管术中推广应用。

Objective To evaluate the value of ultrasound-guided deep vein catheterization in the establishment of vascular access for hemodialysis patients. Methods A total of 200 dialysis patients admitted in our department in 2015, were subjected in the study. Based on 2：1 ratio of the treatment sequence number, the participants were divided into ultrasound localization group （group A, n = 132） and anatomical landmarks of the body surface group （group B, n = 68）. The success rate of catheterization, success rate of one-time puncture, puncture time, and complications （infection within 2 weeks after catheter insertion, hematoma, and puncture of the artery） were compared between the 2 groups. Statistical analyses （ student＇ s t test and Chi square test） were carried out by SPSS 16.0 software. Results The success rate of catheterization were 100% in the 2 groups （P 〉 0.05）. The success rate of one-time puncture into the internal jugular vein and femoral vein was 96.0% and 93.3% respectively in group A, significantly higher than those of group B （70.0% and 62.5% ）. The average time of internal jugular vein and femoral vein punctures was 7.15 ±2.59 and 7.43 ± 3.29 min respectively in group A, significantly shorter than those of group B （ 11.24 ± 6.49 and 12.80 ± 5.78 min, P 〈0.05）. Only 1 patient （0.7%） from group A had complication （hematoma）, but 4 （5.8%） out of group B （arterial puncture and hematoma）. The infection rate within 2 weeks was 2.2% （3 cases） in group A, less than 5 cases （7.3%） in group B. Conclusion Ultrasound-guided deep venous catheterization can improve the success rate of one-time puncture, reduce the operation time, and decrease the incidence of complications. It is worthy of promotion in clinical practice for hemodialysis.