不同超声影像引导平面下颈内静脉穿刺置管效果比较

Comparison of the effect of internal jugular vein puncture and catheterization under different ultrasonic image guidance axis plane plan

目的比较不同超声影像引导平面下颈内静脉穿刺置管效果,探讨最佳的穿刺引导平面。方法选取2014年6月至2016年6月喀什地区第二人民医院收治的需要颈内静脉穿刺置管患者159例,根据穿刺时的超声影像引导平面分为斜轴引导平面组、短轴引导平面组和长轴引导平面组,每组53例。比较3组患者的穿刺总时间、刺入目标血管时间、穿刺点数目、改变进针方向次数、置管成功率及并发症。结果斜轴引导平面组患者穿刺总时间、刺入目标血管时间显著短于短轴引导平面组和长轴引导平面组(P<0.05),短轴引导平面组患者穿刺总时间、刺入目标血管时间显著短于长轴引导平面组(P<0.05)。斜轴引导平面组患者改变进针方向次数显著少于短轴引导平面组和长轴引导平面组(P<0.05),短轴引导平面组患者改变进针方向次数显著少于长轴引导平面组(P<0.05)。3组患者穿刺点数目比较差异无统计学意义(P>0.05)。长轴引导平面组、短轴引导平面组和斜轴引导平面组患者一次性置管成功率分别为69.8%(37/53)、90.6%(48/53)、100.0%(53/53),斜轴引导平面组患者一次性置管成功率显著高于长轴引导平面组和短轴引导平面组(P<0.05),短轴引导平面组患者一次性置管成功率显著高于长轴引导平面组(P<0.05)。长轴引导平面组、短轴引导平面组和斜轴引导平面组患者总置管成功率分别为94.3%(50/53)、96.2%(51/53)、100.0(53/53),3组患者总置管成功率比较差异无统计学意义(P>0.05)。斜轴引导平面组、短轴引导平面组和长轴引导平面组患者并发症发生率分别为0.0%(0/53)、9.4%(5/53)、24.5%(13/53);斜轴引导平面组患者颈内静脉穿刺置管并发症发生率显著低于短轴引导平面组和长轴引导平面组(P<0.05),短轴引导平面组患者颈内静脉穿刺置管并发症发生率显著低于长轴引导平面组(P<0.05)。结论与长轴引导平面、短轴引导平面相比,斜轴引导平面下颈内静脉穿刺置管可以有效提升穿刺置管效率和一次性置管成功率,减少改变进针方向的次数,降低并发症发生率。

Objective To explore the optimal puncture guiding plane by comparing the effect of internal jugular vein puncture and catheterization under different ultrasonic image guidance axis plane plan. Methods A total of 159 patients who needed internal jugular vein puncture and catheterization were selected in Kashgar Prefecture Second People＇ s Hospital from June 2014 to June 2016. All patients were divided into oblique axis guiding plane group,short axis guiding plane group and long axis guiding plane group according to the ultrasonic image guidance axis plane plan during the punctures,53 cases in each group. The total time of punctures,the time of piercing the target vessel,the number of needle hole,the number of times of changing the needling insertion direction,the success rate of catheterization and the complications were compared among the three groups. Results The total time of puncture and the time of piercing the target vessel in the oblique axis guiding plane group were significantly shorter than those in the short axis guiding plane group and long axis guiding plane group（ P 0. 05）;the total time of puncture and the time of piercing the target vessel in the short axis guiding plane group were significantly shorter than those in the long axis guiding plane group（ P 0. 05）. The number of times of changing the needling insertion direction in the oblique axis guiding plane group was significantly less than that in the short axis guiding plane group and long axis guiding plane group（ P 0. 05）,the number of times of changing the needling insertion direction in the short axis guiding plane group was significantly less than that in the long axis guiding plane group（ P 0. 05）. There was no significant difference in the number of needle hole among the three groups（ P 0. 05）. The one-time success rate of catheterization in the long axis guiding plane group,short axis guiding plane group and oblique axis guiding plane group was 69. 8%（ 37 /53）,90. 6%（ 48 /53） and100. 0%（ 53 /53） respectively; the one-time success rate of catheterization in the oblique axis guiding plane group was significantly higher than that in the short axis guiding plane group and long axis guiding plane group（ P 0. 05）,and the one-time success rate of catheterization in the short axis guiding plane group was significantly higher than that in the long axis guiding plane group（ P 0. 05）. The total success rate of catheterization in the long axis guiding plane group,short axis guiding plane group and oblique axis guiding plane group was 94. 3%（ 50 /53）,96. 2%（ 51 /53） and 100. 0%（ 53 /53） respectively; there was no significant difference in the total success rate of catheterization in the three groups（ P 0. 05）. The incidence of complications in the oblique axis guiding plane group,short axis guiding plane group and long axis guiding plane group was 0. 0%（ 0 /53）,9. 4%（ 5 /53） and 24. 5%（ 13 /53）; the incidence of complications in the oblique axis guiding plane group was significantly lower than that in the short axis guiding plane group and long axis guiding plane group（ P 0. 05）,the incidence of complications in the short axis guiding plane group was significantly lower than that in the long axis guiding plane group（ P 0. 05）. Conclusion Compared with the long axis guiding plane and short axis guiding plane,oblique axis guiding plane can effectively promote the efficiency and one-time success rate of internal jugular vein puncture,reduce the number of times of changing the needling insertion direction and the incidence of complications.