短轴法超声引导指向外侧进针在颈内静脉穿刺置管中的应用

Clinical study on short-axis view lateral needle direction ultrasound-guided internal jugular vein catheterization

目的探讨短轴法超声实时引导指向外侧进针在颈内静脉穿刺置管中的临床效果。方法选择西安市第三医院2018年3~12月需行颈内静脉穿刺置管的全麻手术患者120例,采用随机数表法分为观察组和对照组,每组60例,观察组采用短轴法超声实时引导指向外侧进针,对照组采用传统体表标志法,记录两组患者的穿刺置管首次、二次和总成功率,穿刺次数,进针深度,操作时间以及穿刺并发症。结果两组患者的穿刺置管总成功率、穿刺次数、进针深度、操作时间比较差异均无统计学意义(P>0.05);观察组患者的首次成功率为95.0%,明显高于对照组的80.0%,误穿动脉2例(3.3%),明显少于对照组9例(15.0%),差异均有统计学意义(P<0.05);两组患者均无颈部血肿、神经损伤、气胸、血胸等严重并发症。结论短轴法超声引导指向外侧进针行颈内静脉穿刺置管首次成功率高,且降低误穿动脉风险,无严重并发症。

Objective To explore the clinical effect of short-axis view lateral needle direction ultrasound-guided internal jugular vein catheterization.Methods A total of 120 patients requiring internal jugular vein catheterization,who admitted to Xi'an No.3 hospital from March 2018 to December 2018 were divided into two groups according to random number table method,with 60 cases of each group.The internal jugular vein catheterization was performed with the guidance of ultrasound using short-axis view and pointing needle to lateral in observation group,while using surface landmark in control group.First success rate,second success rate,total success rate,puncture times,needle insertion depth,operating time and complications were recorded respectively.Results There was no significant difference in the total success rate,puncture times,needle insertion depth,and operating time between the two groups(all P>0.05).The first success rate in observation group was 95.0%,which was significantly higher than 80.0%in control group(P<0.05),and the cases of arterial puncture in the observation group was 2 cases(3.3%)versus 9 cases(15.0%)in control group(P<0.05).There were no severe complications such as neck hematoma,nerve injury,pneumothorax and hemothorax in the two groups.Conclusion Short-axis view lateral needle direction ultrasound-guided internal jugular vein catheterization has higher first success rate,decreasing the risk of arterial puncture,with no severe complications.