简易体表定位法穿刺腋静脉植入起博电极的临床初步研究

A method of axillary vein puncture using sole anatomical landmark:a preliminary clinical study for pacemaker leads

目的探讨简易体表定位法穿刺腋静脉的临床实用性。方法选取起搏器植入患者96例,随机分为腋静脉穿刺组和锁骨下静脉穿刺组各48例。腋静脉穿刺组将锁骨中内1/3交点作为唯一体表定位点。置18G穿刺针尖于该点锁骨上沿,针体外偏并与矢状长轴夹角45°,针尾处为体表进针点。穿刺针指向锁骨定位点,与胸壁呈30°~45°负压进针穿刺腋静脉。锁骨下穿刺组采用标准锁骨下穿刺方法。对比2组患者静脉穿刺时间、X线下调整穿刺比例、盲穿成功率、穿刺总成功率和血管穿刺相关并发症发生率。结果与锁骨下静脉穿刺组相比,腋静脉组穿刺时间更长(min:3.35±0.97 vs. 2.74±0.90,P<0.01),X线下调整穿刺比例更高(22.91%vs. 8.33%,P<0.05)。2组患者盲穿成功率(70.83%vs. 81.25%)和穿刺总成功率(93.75%vs. 89.58%)差异均无统计学意义(P>0.05)。腋静脉组未出现血管并发症,锁骨下静脉组出现4例。结论简易体表定位法穿刺腋静脉,成功率高,并发症少,具有较高的临床实用性。

Objective To evaluate the clinical value of a novel method of axillary vein puncture using sole anatomical landmark.MethodsA total of 96 consecutive patients referred for pacemaker implantation were enrolled and randomly divided into axillary vein puncture group(n=48) and subclavian vein puncture group(n=48). The junction point of medial and middle third of the clavicle was located as the sole landmark in axillary vein puncture group. Deflected lateral 45° from sagittal line, an 18-guage needle’s tip was laid on the point, and the hub was identified as puncture entry point. The needle was directed to the landmark at approximately 30°~45° relative to the body’s surface. The standard methods of subclavian vein puncture were applied in the other group. The vein puncture time, adjustment puncture ratio under X-ray, success rates of blind puncture and total puncture and complications associated with puncture were compared between the two groups.ResultsCompared with subclavian vein puncture group, there were longer puncture time(min: 3.35±0.97 vs. 2.74±0.90,P<0.01) and more ratio of adjustive puncture under X-ray(22.91% vs. 8.33%, P<0.05) in axillary vein puncture group.There were no significant differences in success rates of blind puncture(70.83% vs. 81.25%) and total puncture(93.75% vs.89.58%) between the two groups(P>0.05). No vascular complications were found in axillary vein puncture group, and four cases of complications associated with puncture were observed in subclavian vein puncture group.ConclusionThe method of axillary vein puncture using sole anatomical landmark has high success rate, less complications and high clinical applicability.