两种超声截面引导下行肝切除术颈内静脉穿刺的比较

Comparison of jugular vein punctures guided by cross-sectional and longitudinal ultrasonic imaging in patients undergoinghepatectomy

目的 探讨超声横截面视图和纵断面视图下引导颈内静脉穿刺对行肝切除术颈内穿刺成功率、定位时间及并发症风险的影响。 方法 选取肝切除术患者90例，采用随机数字表法分为两组（每组45例）：横截面视图组（A组）和纵断面视图组（B组），分别采用横截面视图和纵断面视图超声引导下行颈内静脉穿刺。比较两组患者穿刺成功率、超声引导定位时间及术后并发症发生率等。 结果 两组患者首次及二次穿刺成功率比较，差异均无统计学意义（P〉0.05）；A组患者超声引导定位时间［（8.1±1.4） min］显著低于B组［（15.9±3.1） min］，差异有统计学意义（P〈0.01）；B组患者术后并发症发生率显著低于A组，差异有统计学意义（P〈0.05）。 结论 横截面视图和纵断面视图超声引导用于肝切除术患者颈内静脉穿刺成功率接近，但横截面视图法可有效缩短超声引导定位时间，而纵断面视图法则有助于降低术后并发症发生风险。

Objective To compare the outcomes of jugular vein punctures under the guidance of cross-sectional and longitudinal imaging in patients undergoing hepatectomy, including the success rate of puncture, time for positioning the tubes, and the risk of postoperative complications. Methods Ninety patients undergoing hepatectomy between September 2012 to September 2014 were enrolled in this study. The patients were randomly assigned into A group （n=45） and B group （n=45）, who received jugular vein punctures guided by crosssectional and longitudinal ultrasonic imaging, respectively. Results Both cross-sectional and parasagittal ultrasonic imaging were similarly effective to obtain high success rate in jugular vein punctures（P〉0.05）. The time spent positioning the tubes in A group[（8.1±1.4） min] was significantly shorter than B group[（15.9±3.1） min]（P〈0.01）. But, the risk of postoperative complications in A group was significantly higher than B group（P〈0.05）. Conclusions The guidance of cross-sectional and longitudinal ultrasonic imaging for jugular vein punctures has advantages in faster positioning of tubes and lower risk of complications, respectively.