斜轴面超声方法引导颈内静脉穿刺置管效果观察

Ultrasound guided internal jugular vein catheterization on oblique axial plane

目的评价斜轴面超声方法引导颈内静脉穿刺置管的效果。方法选择需要颈内静脉穿刺置管的手术患者120例，美国麻醉医师协会（ASA）分级Ⅰ至Ⅲ级，年龄25～78岁，性别不限，体重47~81kg。采用随机数字表法，将患者分人短轴组、长轴组和斜轴组，每组40例。短轴组以短轴面即颈内静脉横向截面图下引导颈内静脉穿刺；长轴组以长轴面即颈内静脉长轴截面图下引导颈内静脉穿刺；斜轴组为在环状软骨平面按短轴法定位颈内静脉后，将超声探头顺时针旋转45～55°，获得颈内静脉和周围组织的斜轴面图下引导颈内静脉穿刺。记录并比较3组穿刺次数、一次穿刺成功例数、穿刺成功例数、穿刺失败例数、穿刺时间，以及穿刺并发症的发生情况。结果斜轴组的穿刺时间显著短于短轴组和长轴组（P值均〈O．01），3组间的穿刺次数、一次穿刺成功例数、穿刺成功例数和穿刺失败例数的差异均无统计学意义（P值均〉0．05）。短轴组发生局部血肿4例，误穿动脉0例，穿刺并发症发生率为10．0％；长轴组发生局部血肿2例，误穿动脉1例，穿刺并发症发生率为7．5％；斜轴组发生局部血肿l例，误穿动脉0例，穿刺并发症发生率为2．5％。斜轴组穿刺并发症发生率显著低于短轴组（P〈0．05），与长轴组间的差异无统计学意义（P〉0．05）；长轴组与短轴组间穿刺并发症发生率的差异无统计学意义（P〉0．05）。结论斜轴面超声引导颈内静脉穿刺是一种更加安全、有效的方法。

Objective To evaluate the clinic outcome of ultrasound guided internal jugular vein catheterization on oblique axial plane. Methods One hundred and twenty patients, American Society of Anesthesiologists （ASA） physical status Ⅰ- Ⅲ, aged 25-78 years, no gender preference, weighing 47--81 kg, scheduled for internal jugular vein catheterization, were randomly divided into 3 groups （n = 40）= short axial group, long axial group and oblique axial group. The catheterization was performed through the transverse plane and longitudinal section of the internal jugular vein in the short axial group and long axial group, respectively. In the oblique axial group, after the internal jugular vein was located on the plane of cricoid cartilage according to the short axis method, the ultrasonic sensor was rotated 45 -- 55 degrees clockwise to finish catheterization in this plane. The number of puncture, one-time puncture success cases, puncture success or failure cases, puncture time, and puncture complications were recorded and compared in three groups. Results Compared with short axial group and long axial group, the puncture time was significantly reduced in oblique axial group （both P〈 0.01）. There were no significant differences in the number of puncture, one-time puncture success cases, puncture success or failure cases between groups （all P〉0.05）. In short axial group, local hematoma occurred in 4 cases, and the incidence of puncture complications was 10.0 %. In long axial group, local hematoma occurred in 2 cages and artery perforation occurred in 1 case, and the incidence of puncture complications was 7.5%. In oblique axial group, local hematoma occurred in 1 case, and the incidence of puncture complications was 2.5%. The incidence of puncture complications in oblique axial group was significantly lower than that in short axial group （P〈0.05）.There was no significant difference in the incidence of puncture complications between long axial group and oblique axial group, or between long axial group and short axial group （both P〈0.05）. Conclusion Ultrasound guided catheterization on oblique axial plane of the internal jugular vein is safe and effective.