超声引导在CT增强检查静脉留置针穿刺困难患者中的应用研究

Application of ultrasound guidance in patients with difficulty in intravenous indwelling needle puncture during contrast-enhanced computed tomography

目的:探讨超声引导在CT增强检查静脉穿刺困难患者中留置针穿刺的可行性及操作要点。方法:将46例血管情况差的患者作为对照组,应用常规留置针穿刺法进行穿刺;将43例常规穿刺失败患者纳入实验组,应用超声引导留置针穿刺法进行穿刺。采用卡方检验法,比较2组穿刺成功率、穿刺并发症;采用配对样本t检验法,比较2组患者选血管用时、穿刺次数、进针次数。结果:46例常规穿刺患者3例穿刺成功,43例超声引导穿刺均成功,其中一次穿刺成功38例,二次穿刺成功5例,穿刺成功率高达100%,实验组与对照组相比,一次穿刺成功率(χ^2=70.940,P=0.000)、总成功率(χ^2=77.770,P=0.000)均有明显差异,其并发症发生率也明显降低(χ^2=15.151,P=0.000);选血管用时明显缩短(3.65±1.57 vs. 36.86±7.11,t=32.412,P<0.01);穿刺次数明显减少(1.12±0.32 vs. 3.56±0.50,t=31.866,P<0.01);进针次数明显减少(1.21±0.47 vs. 7.56±1.65,t=23.685,P<0.01)。结论:将超声引导留置针穿刺术应用于CT增检查静脉穿刺困难患者中,提高了穿刺成功率,减轻了患者痛苦,为患者顺利完成CT增强检查提供了保障,其操作简单、安全,值得临床推广。

Objective:To investigate the feasibility and operating points of ultrasound guidance in indwelling needle puncture in patients with difficulty in venipuncture during contrast-enhanced computed tomography(CT). Methods:A total of 46 patients with poor vascular conditions were enrolled as control group and were given venipuncture with the conventional indwelling needle puncture method,and 43 patients with failed venipuncture were enrolled as experimental group and were given ultrasound-guided venipuncture. The chi-square test was used to compare puncture success rate and complications between two groups,and the paired samples t-test was used to compare the time spent on vessel selection,number of times of puncture,and number of times of needle insertion between two groups. Results:Three patients in the control group had successful puncture,while all 43 patients in the experimental group had successful puncture under ultrasound guidance,among whom 38 had successful one-time puncture and 5 had successful puncture after two times of puncture,resulting in a puncture success rate of 100%. There were significant differences between the experimental group and the control group in the success rate of one-time puncture(χ^2=70.940,P=0.000)and overall success rate(χ^2=77.770,P=0.000),and the experimental group had a significantly lower incidence rate of complications than the control group (χ^2=15.151,P=0.000). Compared with the control group,the experimental group had significantly shorter time spent on vessel selection(3.65±1.571 vs. 36.86±7.11,t=32.412,P<0.01)and significantly lower numbers of times of puncture(1.12±0.32 vs. 3.56±0.50,t=31.866,P<0.01)and needle insertion(1.21±0.47 vs. 7.56±1.65,t=23.685,P<0.01). Conclusion:In patients with difficulty in venipuncture,ultrasound-guided indwelling needle puncture can improve puncture success rate,alleviate pain,and help them to undergo a successful CT examination. The operation is simple and safe,thus holding promise for clinical application.