超声引导下颈内静脉血液透析导管置管术应用分析

目的总结颈内静脉穿刺置管的经验，探讨超声引导下颈内静脉穿刺置管在血液透析中的应用价值。方法回顾两年多来超声引导下和盲穿的颈内静脉透析导管置管术的88例临床病例。使用超声引导穿刺置管46例，使用传统盲法穿刺置管42例，比较两种方法行颈内静脉穿刺置管术的穿刺置管时间、穿刺成功率和并发症发生情况。结果行传统盲穿法平均穿刺置管时间（18．6±6．0）min，首次穿刺成功率51．4％，穿刺总体成功率92．8％，平均穿刺次数2．5次，穿刺并发症发生率12％，使用超声引导下穿刺置管法平均穿刺置管时间（14．5±4．5）min，首次穿刺成功率93．2％，穿刺总体成功率100％，平均穿刺次数1．2次，穿刺并发症发生率2．2％。结论超声定位下行颈内静脉血液透析导管置管术与传统盲穿比较穿刺成果率高，时间短，并发症少，是安全、可靠、高效，并且较为简便易行的一种微创诊疗手段，值得临床上进一步推广应用。

Objective To accumulate experience of internal-jugular vein catheterization and investigate the value of ultrasound guided internaljugular vein catheterization with hemodialystic catheter. Methods A retrospective study was performed on of 88 clinical cases of ultrasoud or blind guided internal-jugular vein catheterization with hemodialystic catheter in our hospital in the past two years, among which 46 cases were catheterized with guidance of ultrasound and 42 were blind-guided, and a comparison was made on the catheterization time, success rates and complication rates of the two methods. Results The average time of tradional blind guided catheterization was 18.6 ± 6.0 minutes, the first-time success rate was 51.4%, the total success rate was 92.8%, the complication rate was 12%, and average 2.5 punctures per patient. While with the guidance of ultrasound. the average catheterization time was 14.5 ± 4.5 minutes, the first-time success rate was 93.2%, the total success rate was 100%, the complication rate was 2.2% and average 1.2 punctures per patient. Conclusion Ultrasound guided internal-jugular vein catheterization with hemodialystie catheter has a higher success rate, less complication, less time than that of the traditional blind guided catheterization and is a safe, reliable, efficient, and easy-to-go mini-invasive therapy, which deserves further application.