实时超声引导静脉穿刺在增强CT检查肥胖患儿中的应用价值

Applicability of ultrasound guide venipuncture in contrast-enhanced CT examinations of obese children

目的探讨实时超声引导及动脉穿刺针用于肥胖患儿肘正中静脉穿刺置管进行增强CT检查的临床效果及优势。方法选取2013-12至2015-10我院小儿骨科及骨肿瘤科收治年龄5~14周岁,体重指数BMI>24,拟行肘正中静脉穿刺置管的患儿共60例进行本研究,按计算机生成随机数字表分为传统操作方法组(TM组,n=30)及实施超声引导组(UG组,n=30)。观察并记录两组的穿刺准备时间、穿刺置管时间、总时间、进针次数及成功率,置管成功后即刻及置管后24 h观察并记录有无并发症的发生,置管后24 h随访家长对穿刺工作满意度。结果 US组穿刺置管前准备时间(3.4±0.7)min较TM组(1.9±0.7)min较长,差异有统计学意义(P<0.01),穿刺置管时间明显短于TM组[TM组(3.8±4.9)min vs US组(1.4±0.5)min,P=0.041],两组患者总操作时间差异无统计学意义;US组进针次数均为1针,明显少于TM组(TM组2.0±1.8次vs US组1.0±0.0次,P=0.028),两组患儿出现并发症情况、患儿配合度及家长满意度差异无统计学意义。结论超声引导肘正中静脉穿刺可以明显缩短穿刺时间,明显减少反复进针次数,提高置管成功率,避免并发症发生。

Objective To explore the clinical effect and advantages of the ultrasound-guided arterial puncture needle in the puncture tube of the median cubital vein of obese children. Methods Sixty children aged 5 to 14 with a weight index of BMI 〉 24 and to be treated via the puncture tube in the median cubital vein in the Department of Orthopedics for Children between December 2013 and October 2015 were selected and randomly divided into the traditional method group （TM group, n = 30） and the ultrasound-guidod group （US group, n = 30） according to the random number table generated by the computer. The time taken to prepare for the punc- ture, the time taken to insert the puncture tube, the total time, needle insertion times and success rate, the time after the successful tube insertion,the time the children left the operating room, and the occurrence of complications 24 h after operation were observed and recorded. 24 h after operation, a follow-up was conducted to inquire about patients＇ satisfaction with the surgery. Results The US group took a longer time to get ready for the puncture tube （ TM group 1.9 ± 0.7 min vs 3.4 ± 0.7 min, P 〈 0.01 ）, but took much less time to insert the puncture tube than the TM group （ TM group 3.8 ± 4.9 min vs US group 1.4 ± 0.5min, P = 0. 041 ）. There was no statistically significant difference of the total operation time between the two groups of patients （P = 0.422）. The number of needle insertion was one in the US group ,which was obviously smaller than that of TM group （ TM group 2.0 ± 1.8 times vs US group 1.0 ± 0.0 times, P = 0. 028）, but there was no statistically significant difference in the success rate, compliance and degree of satisfaction between the two groups （ P = 0. 487）. Conclusions The median cubital vein puncture with the guidance of ultrasound is safe and reliable, which can shorten the puncture time, reduce the times of repeated needle insertion, improve the success rate and prevent complications.