超声引导下经外周静脉导入中心静脉置管术的临床应用

Clinical application of ultrasound-guided central venous catheterization

目的研究超声引导对经外周静脉导入中心静脉置管术(PICC)的影响。方法选择100例需行中心静脉置管的患者,随机均分2组,对照组按照传统操作步骤,肉眼观察右颈内静脉,评估穿刺可行性并排除解剖变异,使用PICC穿刺包完成穿刺;观察组在超声引导下完成中心静脉置管,选用索诺声超声仪(M-terbo),在高频探头下获得有效的穿刺指引,判断血管准确位置并查看是否穿刺成功,可顺利回抽静脉血后以改良塞丁格法将PICC导管置入。比较2组穿刺情况及置管相关并发症的差异。结果对照组平均穿刺时间为(19.67±2.85)min,观察组平均(10.55±2.49)min,差异具有统计学意义(P<0.05);对照组一次性穿刺成功率为84%(42/50),观察组一次性穿刺成功率为98%(49/50),差异具有统计学意义(P<0.05);对照组并发症总发生率为28%,观察组为4%,观察组总发生率明显低于对照组(P<0.05)。结论超声引导下PICC置管的穿刺时间更短、一次性穿刺成功率更高、置管相关并发症发生率更低,具有临床推广价值。

Objective To study the influence of ultrasound guidance on central venous catheterization.Methods 100 patients req uiring central vein catheterization were randomly divided into two groups.The control group followed the traditional operation steps to observe the right internal jugular vein naked eye,evaluate the feasibility of puncture and eliminate anatomical variation,and complete puncture with PICC puncture kit. Observation group in the center of the ultrasound guided finish venipuncture,choose sound sonoma ultrasonic instrument(M-terbo),get effective puncture guided under high frequency probe,under ultrasound to determine whether a vascular accurate position and view the puncture success and smooth back after phlebotomize with improved dingle method of PICC catheter placement,compare the puncture and catheter related complications were similar between the two groups. Results The average puncture time of the control group was(19.67±2.85)min,and that of the observation group was(10.55±2.49)min. The comparison between the two groups was statistically significant(P<0.05).The one-time puncture success rate of the control group was 84%(42/50),and that of the observation group was 98%(49/50).The comparison between the two groups was statistically significant(P<0.05).The total incidence of complications was 28% in the control group and 4% in the observation group,which was significantly lower than that in the control group.Conclusion Guided central venous catheterization has shorter puncture time,higher one-time puncture success rate and lower incidence of catheterization related complications,which has clinical promotion value.