超声引导下双点标记法应用于婴幼儿右颈内静脉穿刺置管术的随机对照研究

A study of ultrasound-guided double-point labeling for right internal jugular vein puncture and cannulation in infants with randomly set control group

目的探讨超声引导下双点标记法在婴幼儿右颈内静脉穿刺过程中的应用。方法120例行颈内静脉穿刺的婴幼儿,按随机数字表法分为3组(每组40例):传统解剖定位组(M组),采用传统的颈动脉搏动触诊和其他解剖标志物的方法,对患者右颈内静脉穿刺进行插管;超声实时引导组(C组),采用飞利浦CX30超声系统L12-4探头,对血管穿刺部位进行二维超声扫描,实时引导操作;超声预先标记后进行操作组(L组),采用飞利浦CX30超声系统L12-4探头,对血管穿刺部位进行超声定位,作两个标记,以这两个点标记引导操作。记录各组穿刺次数、操作时间(从开始消毒到固定敷贴完毕)、穿刺成功率和并发症发生率。结果C组和L组穿刺一次成功率比较差异无统计学意义(P>0.05),但都高于M组(P<0.05);C组和L组穿刺次数差异无统计学意义(P>0.05),但都低于M组(P<0.05);C组和L组操作时间差异无统计学意义(P>0.05),但都少于M组(P<0.05)。并发症主要为穿刺血肿和动脉损伤,M组穿刺血肿和动脉损伤发生例数明显高于C组和L组(P<0.05)。结论超声引导下双点标记法用于婴幼儿右颈内静脉穿刺,在成功率和并发症方面优于传统解剖定位法。

Objective To evaluate the double-point labeling under ultrasonography for right internal jugular vein puncture cannulation in infants.Methods One hundred and twenty infants scheduled for surgery were randomly divided into 3 groups(n=40):traditional anatomical location group(group M),patients′right internal jugular vein puncture,were cannulated by using the traditional method of palpation of carotid pulsation and identification of other anatomic landmarks.Real-time ultrasound guidance group(group C),a two-dimensional ultrasound scanner image made for locating the puncture site of vessels was used with an operative probe of PHILIPS CX30 system,L12-4 probe unit,real-time boot operation.Ultrasound pre-labeling followed by operation group(group L),an ultrasonic pre-locating two points,which made for locating the puncture site of vessels was used with an operative probe of PHILIPS CX30 system,L12-4 probe unit.The number of attempts,success rate and incidence of complications were compared among three groups.Results There was no significant difference in one-time success rate between group C and group L,but the rates of both groups were higher than the rate of group M(P<0.05).There was no significant difference in puncture times between group C and group L,but the times of both groups were lower than the time of group M(P<0.05).Also,there was no significant difference in operation time between group C and group L,but the times in both groups were less than the time of group M(P<0.05).The main complications were puncture hematoma and arterial injury,the incidence of hematoma and arterial injury in group M were significantly higher than that in group C and L(P<0.05).Conclusions Two points pre-localization under ultrasonography for the right internal jugular vein puncture is superior to the anatomic landmark technique in terms of successful rate and complications.