减少锁骨下静脉穿刺并发症方法探讨(附1480例分析)

Methods to reduce the complications after subclavian vein catheter:an analysis of 1480 cases

目的:结合行锁骨下静脉穿刺经验,探讨减少穿刺术中并发症的措施。方法:回顾性分析2018年1月1日至2020年1月1日在北京大学肿瘤医院静脉通路中心进行中心静脉置管的1480例病人。结果:所有病人中196例首先尝试行左侧锁骨下静脉穿刺,1284例首先尝试行右侧锁骨下静脉穿刺,其中左侧锁骨下静脉穿刺3针及以内成功172例(87.8%),右侧为1108例(86.3%),两组差异无统计学意义(P>0.05)。3针以内未成功者改行颈内静脉或B超引导下锁骨下-腋静脉穿刺,总体成功率100%。本组共2例(1.4‰)出现气胸。本组病人穿刺过程中置入导丝时导丝上拐至颈内静脉,左侧出现5例(2.6%),右侧出现80例(6.2%),两组差异具有统计学意义(P<0.05)。术中经过B超辅助调整导丝位置再置管,术后复查胸片无导管异位发生。结论:在锁骨下静脉穿刺中避免同一部位反复穿刺,可以减少气胸发生。在锁骨下静脉穿刺术中通过助手辅助行B超检查判断置入导丝是否拐入颈内静脉,若拐入颈内静脉及时重新调整导丝可以减少术后导管异位。

Objective:To find some measures to reduce the complications after subclavian vein(SCV)catheter.Methods:We did a retrospective analysis of 1480 patients who were placed SCV catheter in central venous access center of our hospital from January 1st,2018 to January 1st,2020.Results:Of all patients,196 patients were first planned to place in the left SCV,1284 cases in the right.Among them,172 cases(87.8%)in the left and 1108 cases(86.3%)in the right SCV was successfully finished within three times.The difference was not statistically significant(P>0.05).Those who failed were placed in internal jugular vein or in subclavian axillary vein guided by ultrasound.The overall success rate was 100%.Pneumothorax was found in 2 patients(1.4‰).In 5 cases(2.6%)the guide wire turned upward into the internal jugular vein in the left SCV puncture,80 cases(6.2%)in the right SCV puncture,and the two groups showed significant difference(P<0.05).After readjusting the position of the guide wire assisted by B ultrasound,there was no misplacement confirmed by chest X-ray.Conclusion:Avoiding repeated subclavian venipuncture in the same site could reduce the rate of pneumothorax.During the subclavian venipuncture,B-ultrasonic examination was performed to judge whether the guide wire was inserted into the internal jugular vein and to avoid the misplacement of the catheter in time.