超声预定位外斜穿刺法在肥胖患者右颈内静脉穿刺置管中的应用

Application of ultrasound pre-positioned external oblique puncture method for right internal jugular vein catheterization in obese patients

目的:评价超声预定位外斜穿刺法在肥胖患者右颈内静脉穿刺置管中的临床应用效果。方法:选择择期气管插管全身麻醉下手术肥胖患者(体质指数BMI≥30 kg·m-2)150例,按照随机数字表法将患者分为3组:实时超声引导组(RUG组)、超声预定位外斜穿刺法组(UPE组)和超声预定位中线穿刺法组(UPM组),每组50例。RUG组在实时超声引导下行右颈内静脉穿刺置管,UPE组采用超声预定位外斜穿刺法行右颈内静脉穿刺置管,UPM组采用超声预定位中线穿刺法。记录3组穿刺成功率、置管成功率、穿刺置管时间以及穿刺置管并发症(误入动脉、血肿、气胸、血胸等)的发生情况。结果:与RUG组比较,UPE组和UPM组穿刺置管时间短(P<0.05),UPE组和UPM组穿刺置管时间比较差异无统计学意义(P>0.05)。3组穿刺一次成功率、置管一次成功率、穿刺置管总成功率及误穿动脉发生率比较差异无统计学意义(P>0.05)。结论:与实时超声引导比较,超声预定位外斜穿刺法和超声预定位中线穿刺法用于肥胖患者右颈内静脉穿刺置管均缩短操作时间,具有操作简单、方便、迅速的优点。

Objective:To evaluate the clinical effect of ultrasound pre-positioned external oblique puncture method for right internal jugular vein(IJV)catheterization in obese patients.Methods:One hundred and fifty obese cases(body mass index,BMI≥30 kg·m-2)undergoing surgery scheduled for endotracheal intubation general anesthesia,according to the random number table method,were divided into three groups:real-time ultrasonic guidance group(group RUG),ultrasound pre-positioned external oblique puncture method group(group UPE)and ultrasound pre-positioned midline puncture method group(group UPM),with 50 cases in each group.The puncture success rate,catheterization success rate,puncture catheterization time and the occurrence of puncture catheterization complications(strayed into the artery,hematoma,pneumothorax,hemothorax,etc.)were recorded in the three groups.Results:Compared with group RUG,the puncture catheterization time of group UPE and group UPM was significantly shortened(P<0.05).There was no significant difference in puncture catheterization time between group UPE and group UPM(P>0.05).There were no statistically significant differences in the success rate of the first puncture,the success rate of the first catheterization,the total success rate of puncture and catheterization and the incidence of strayed into the artery among the three groups(P>0.05).Conclusion:Compared with real-time ultrasound guidance,ultrasound pre-positioned external oblique puncture method and ultrasound pre-positioned midline puncture method for the right IJV puncture catheterization in obese patients both significantly shorten the operation time and have the advantages of simple operation,convenience and rapidity.