改良穿刺法与传统穿刺法在锁骨下静脉穿刺术中应用效果的比较

Comparison of the effects of modified puncture and traditional puncture on subclavian vein puncture

目的 比较改良穿刺法与传统穿刺法在锁骨下静脉穿刺术中的穿刺成功率及并发症,探索更加安全、高效的锁骨下静脉穿刺方法.方法 前瞻性选取2016年6月—2017年6月200例拟行全身麻醉锁骨下静脉穿刺置管的患者,其中男100例、女100例,年龄17～83岁.依随机数字表法分为传统组、改良组、传统B超组、改良B超组,每组50例,分别采用传统穿刺法、改良穿刺法、B超引导传统穿刺法和B超引导改良穿刺法行锁骨下静脉穿刺置管.比较4组的穿刺成功率、穿刺时间、穿刺次数及相关并发症的发生率.结果 （1）改良组穿刺总成功率为98.0％（49/50）、一次穿刺成功率为90.0％（45/50）,高于传统组的94.0％（47/50）和64.0％（32/50）;改良组穿刺次数明显少于传统法组,穿刺时间短于传统组,总并发症发生率低于传统组;差异均有统计学意义（P值均〈0.05）.（2）改良组、改良B超组和传统B超组一次穿刺成功率高于传统组（P值均〈0.01）.（3）改良B超组和传统B超组穿刺时间、穿刺次数比较,差异均无统计学意义（P值均〉0.05）.结论 改良穿刺法较传统穿刺法在锁骨下静脉穿刺术临床应用中的优势明显,其穿刺成功率更高,并发症更少,值得推广;超声引导下行锁骨下静脉穿刺置管成功率高,并发症少,更加安全高效,尤其对于穿刺困难的患者,有重要的临床实用价值.

Objective To compare the success rate of puncture and complications in subclavian vein puncture between modified puncture and traditional puncture, and explore a safer and more effective subclavian puncture method.Methods From June 2016 to June 2017, 200 patients （100 males and 100 females） who underwent subclavian vein catheterization were randomly divided into traditional group, modified group, traditional ultrasound group and modified ultrasound group 50 patients in each group. The traditional puncture method and modified puncture method, ultrasound-guided traditional puncture and ultrasound-guided were used to improve puncture line subclavian vein catheterization. The puncture success rate, puncture time, punctures frequency and related complications were compared between the 4 groups.Results （1） The successful rate of puncture assembly in the modified group was 98.0%（49/50） and the success rate of primary puncture was 90.0%（45/50）, which were significantly higher than those in the traditional group [94.0%（47/50） and 64.0%（32/50）, all P values＜0.05]. The puncture time was shorter than that of the traditional group （P＜0.05）. The overall complication rate was lower than that of the traditional group （P＜0.05）. （2） The successful rate of single puncture in the modified group, modified ultrasound group and traditional ultrasound group was higher than that in the traditional group （all P values＜0.01）. （3） There was no significant difference in puncture time and puncture frequency between modified ultrasound group and traditional ultrasound group （all P values〉0.05）. Conclusions Ultrasound guided descending subclavian vein catheterization is safer, with high success rate and fewer complications, especially for patients with difficult puncture. The improved puncture method has obvious advantages over the traditional puncture in the clinical application of subclavian vein puncture, the puncture success rate is higher, less complications, it is worth promoting. Ultrasound guided descending subclavian vein catheterization success rate, less complications, more safe and efficient, especially for patients with puncture difficulties, there is an important clinical value.