超声引导中心静脉穿刺置管在血液滤过治疗中的应用价值

THE APPLICATION VALUE OF ULTRASOUND-GUIDED CENTRAL VENOUS CATHETERIZATION IN HEMOFILTRATION

目的探讨超声引导中心静脉穿刺置管在血液滤过治疗中的应用价值。方法选取2013年1月—2016年12月我院收治的90例急性肾损伤需要进行血液滤过治疗的患者,随机分为体表解剖定位组(对照组)及超声引导定位组(观察组),每组45例,对照组采用传统的解剖标志点盲探穿刺置管,观察组在超声实时定位引导下穿刺置管,观察记录患者右侧颈内静脉与颈总动脉、股静脉与股动脉的关系及血管异位情况,并比较二组患者穿刺时间、一次穿刺成功率、穿刺总成功率及并发症的差异。结果超声探查显示右侧颈内静脉与颈总动脉呈并行关系占49.1%,呈重叠关系占40.4%,异位占10.5%;股静脉与股动脉呈并行关系占54.5%,呈重叠关系占33.3%,异位占12.1%。与对照组比较,观察组的一次穿刺成功率及总成功率明显升高,穿刺时间显著降低(P均<0.05);且穿刺置管的并发症发生率显著降低(P<0.05)。结论对于血液滤过需行中心静脉置管的急性肾损伤患者,超声引导穿刺置管较体表解剖定位操作时间短,成功率高,更为安全,具有较好的临床价值。

Objective To investigate the effect of ultrasound-guided central venous catheterization in the patients with hemofiltration.Methods Ninety patients with acute renal injury,who underwent central venous catheterization were retrospectively analyzed.The patients were divided into two groups,45 cases in each group,including experimental group with real-time ultrasound-guided catheterization and control group with blindly traditional anatomical landmark puncture.The relationship between internal jugular vein and carotid artery,femoral vein and femoral artery,success rate of puncture,and incidence of complications were compared in two groups.Results Ultrasound scan revealed that the relationships between right internal jugular vein and right carotid artery could be divided into three types：parallel（49.1%）,overlapping（40.4%）,angiectopia（10.5%）.The relationships between femoral vein and femoral artery could be divided into three types：parallel（54.5%）,overlapping（33.3%）,angiectopia（12.1%）.Success rate of one puncture and total puncture in experimental group were higher than those in control group,and time spent for catheterization was significantly shorter in experimental group,compared with that in control group,respectively（P〈0.05）,but the incidence of complications was significantly lower in experimental group than that in control group（P〈0.05）.Conclusion Ultrasound-guided central venous catheterization results in higher success rate and less related complication,which can be recommended for widely application in treatment of hemofiltration patients with acute renal injury,who undergo central venous catheterization.