超声引导下显影线辅助定位联合平面外动态针尖法在颈内静脉置管培训中应用

Application of ultrasound-guided imaging line assisted positioning combined with out-of-plane dynamic needle tip method in the training of neonatal internal jugular vein catheterization

目的:评价超声引导下显影线辅助定位联合平面外动态针尖法在麻醉科培训医师颈内静脉穿刺置管中的应用效果。方法:选取麻醉科培训医师30名,按照不同穿刺方法随机分为对照组和改良组,每组15名,两组均按计划行超声技术理论学习、模型操作培训及临床实践。对照组医师以传统静态超声平面外定位技术行颈内静脉穿刺置管,改良组医师采用超声引导下显影线辅助定位联合平面外动态针尖法行颈内静脉穿刺置管。比较使用两种穿刺方法的首次穿刺成功率、总成功率、穿刺置管时间。通过调查问卷评价受训医师对穿刺方法临床效果的评价及满意度。结果:改良组首次穿刺置管成功率和总成功率分别为84.4%和93.3%,显著高于对照组的62.2%和75.5%,差异有统计学意义(P<0.05);改良组穿刺置管时间为(10.2±2.8)min,显著短于对照组(13.1±2.7)min,差异明显(P<0.05)。结论:超声引导下显影线辅助定位联合平面外动态针尖法可显著提高麻醉科培训医师颈内静脉穿刺置管的首次成功率和总成功率,缩短置管时间,改善临床培训效果和质量,具有推广的可行性和必要性。

Objective:To evaluate the application effect of ultrasound-guided imaging line assisted positioning combined with out-of-plane needle tip dynamic method in internal jugular vein puncture catheterization of anesthesiologists.Methods:Thirty trained anesthesiologists were selected and randomly divided into a control group and an improved group(n=15)according to different puncture methods.Both groups received ultrasound technology theory study,model operation training and clinical practice according to the plan.The physicians in the control group performed internal jugular vein puncture catheterization with traditional static ultrasound out-of-plane positioning technology,and the physicians in the modified group performed internal jugular vein puncture catheterization with ultrasound-guided visualization line assisted positioning combined with out-of-plane dynamic needle tip method.Compare the first puncture success rate,total success rate,and puncture placement time of the two puncture methods.The questionnaire was used to evaluate the doctor’s evaluation and satisfaction with the effect of the puncture method.Results:The first puncture and catheter placement success rate and total success rate of the modified group were 84.4%and 93.3%,which were significantly higher than the 62.2%and 75.5%of the control group.The difference was statistically significant(P<0.05);the modified group puncture catheterization time It was(10.2±2.8)min,which was significantly shorter than(13.1±2.7)min in the control group(P<0.05).Conclusion:The ultrasound-guided imaging line assisted positioning combined with the out-of-plane dynamic needle tip method can significantly improve the first success rate and total success rate of internal jugular vein puncture catheterization for anesthesiologists,shorten the catheterization time,Improving the effect and quality of clinical training is feasible and necessary for promotion.