超声引导颈内静脉穿刺置管中三种超声平面引导技术的随机比较研究

Randomized Comparison of Three Transducer Orientation Approaches for Ultrasound Guided Internal Jugular Venous Cannulation

目的:评估和比较实时床旁超声引导颈内静脉穿刺置管中短轴法,长轴法和斜轴法的临床效果,探讨最佳穿刺超声引导平面。方法:本院急诊科收治的患者105例,年龄23~88岁,按计算机随机分为短轴法组、长轴法组和斜轴法组,每组35例。在床旁超声引导下使用三种不同的引导平面行颈内静脉穿刺置管术。记录三组颈内静脉穿刺置管术的第一针穿刺目标血管成功率、穿刺次数、置管时间,并记录三组颈内静脉穿刺置管术的机械并发症的发生率。结果:总共对105例患者进行研究分析。短轴法组,长轴法组和斜轴法组各35例。第一针的穿刺成功率短轴法组25例(69.4%),长轴法组19例(54.3%),和斜轴法组27例(79.4%)。长轴法组的第一针穿刺失败率高于斜轴法组(P<0.05)。短轴法组的机械并发症发生率(15.1%)比长轴法组(6.9%)和斜轴法组(4%)高。结论:与短轴法,长轴法比较,用斜轴法进行超声引导下颈内静脉穿刺的第一针穿刺成功率高于长轴法,而机械并发症的发生率低于短轴法。推荐斜轴法作为超声引导下颈内静脉穿刺的标准方法。

Objective:To compare the effect of short axis ultrasound guided puncture with that of long axis puncture.Methods:105 patients,aged 23-88 years,were randomly divided into short axis group,long axis method group and oblique axis method group,35 cases in each group.Three different guiding planes were used for internal jugular vein catheterization guided by bedside ultrasound.The success rate of the first puncture target vessel,puncture times and catheterization time of the three groups were recorded,and the incidence of mechanical complications of internal jugular vein puncture and catheterization was recorded.Results:a total of 105 patients were studied and analyzed.There were 35 cases in the short axis group,35 cases in the long axis group and 35 cases in the oblique axis group.The success rate of the first puncture was 69.4%in the short axis group,54.3%in the long axis group and 79.4%in the oblique axis group.The first puncture failure rate of long axis group was higher than that of oblique axis method group(P<0.05).The incidence of mechanical complications in the short axis group(15.1%)was higher than that in the long axis group(6.9%)and the oblique axis group(4%).Conclusion:compared with short axis method and long axis method,the success rate of the first puncture of internal jugular vein guided by oblique axis method is higher than that of long axis method,while the incidence of mechanical complications is lower than that of short axis method.Oblique axis method is recommended as the standard method for ultrasound-guided internal jugular vein puncture.