改良超声引导动态针尖定位技术与解剖标志定位用于婴幼儿颈内静脉穿刺的比较

Comparison of Modified Ultrasound-guided Dynamic Needle Tip Positioning Technique and Anatomic Landmarks for Internal Jugular Vein Puncture in Infants

目的比较改良超声引导下动态针尖定位技术和解剖标志定位在婴幼儿颈内静脉穿刺的成功率和并发症。方法选取2018年9月至2019年1月上海交通大学医学院附属上海儿童医学中心择期在体外循环下行先天性心脏病纠治手术的108例婴幼儿作为研究对象,按照随机数字表法分为超声组和解剖组,各54例。其中,超声组采用改良超声引导下动态针尖定位技术行右侧颈内静脉穿刺置管,解剖组采用传统解剖标志定位的方法行右侧颈内静脉穿刺置管。记录并比较两组患儿穿刺的总体成功率、穿刺时间、一次穿刺成功率、穿刺针进针次数、皮肤穿刺点数量和并发症(导管异位、误穿动脉、导管源性感染、血栓、气胸、血胸、神经损伤)发生情况。结果超声组患儿穿刺的总体成功率和一次成功率高于解剖组[94.4%(51/54)比81.5%(44/54),85.2%(46/54)比68.5%(37/54)],穿刺时间长于解剖组[96.5(84.0,108.5)s比82.5(74.5,89.5)s],进针次数和皮肤穿刺点数量少于解剖组[(1.2±0.6)次比(3.5±1.0)次,0.6(0.5,0.9)个比1.2(1.0,1.9)个](P<0.05)。超声组患儿误穿动脉的发生率显著低于解剖组[0比9.3%(5/54)](P<0.05)。体重>10 kg组的穿刺时间长于体重<10 kg组[90.0(86.0,96.0)s比71.5(59.8,81.8)s](P<0.01)。结论与解剖标志定位相比,改良超声引导下动态针尖定位技术提高了婴幼儿右侧颈内静脉穿刺的成功率,同时减少了患者的创伤和围手术期并发症。

Objective To compare the overall success rate and complications of internal jugular vein puncture in infants with improved ultrasound-guided dynamic needle tip positioning technique and anatomical landmark positioning.Methods 108 infants with congenital heart disease undergoing cardiac surgery under cardiopulmonary bypass in Shanghai Children′s Medical Centre,School of Medicine,Shanghai Jiaotong University from Sep.2018 to Jan.2019 were included.They were divided into an ultrasound group and an anatomical group according to the random number method,54 cases in each group.In the ultrasound group,the modified ultrasound-guided dynamic needle tip positioning technique was used for the right internal jugular vein catheterization,while in the anatomical group,the traditional anatomical landmark positioning method was used for the right internal jugular vein catheterization.The overall success rate,puncture time,first-attempt puncture success rate,number of puncture points,number of skin puncture points and complications(ectopic catheter,wrong puncture of artery,catheter-derived infection,thrombosis,pneumothorax,hemothorax and nerve injury)were recorded and compared between the two groups.Results The overall success rate and first-attempt success rate of puncture in the ultrasound group were higher than those of the anatomical group[94.4%(51/54)vs 81.5%(44/54),85.2%(46/54)vs 68.5%(37/54)],the puncture time was longer than that of the anatomical group[96.5(84.0,108.5)s vs 82.5(74.5,89.5)s],the number of needle insertions and the number of skin puncture points were less than those of the anatomical group[(1.2±0.6)times than(3.5±1.0)times,0.6(0.5,0.9)vs 1.2(1.0,1.9)](P<0.05).The incidence of accidental artery penetration in the ultrasound group was significantly lower than that of the anatomical group[0 vs 9.3%(5/54)](P<0.05).The puncture time in the group with body weight>10 kg was longer than that in the group with weight<10 kg[90.0(86.0,96.0)s vs 71.5(59.8,81.8)s](P<0.01).Conclusion Compared with anatomical landmark positioning,modified ultrasound-guided dynamic needle tip positioning technique improves the success rate of central venous catheterization and decreases the injury to children and related perioperative complications.