超声引导锁骨上入路锁骨下静脉穿刺在颅脑手术中的应用效果

Application of ultrasound-guided subclavian vein puncture via supraclavicular approach in craniocerebral surgery

目的探讨超声引导锁骨上入路锁骨下静脉(SCV)穿刺在颅脑手术中的应用效果。方法选择80例需要中心静脉置管的颅脑手术患者,随机分为锁骨下入路组(n=40)和锁骨上入路组(n=40)。记录2组SCV长轴图像超声定位时间;测量2组SCV长轴图像与探头的垂直距离;测量2组SCV的平均内径;记录2组穿刺时间、总穿刺次数、一次穿刺成功率、总穿刺成功率;记录2组误穿动脉、气胸等并发症的发生情况。结果与锁骨下入路组相比,锁骨上入路组SCV长轴图像超声定位时间更短(P<0.05),SCV长轴图像与探头的垂直距离更短(P<0.05),SCV的平均内径明显较长(P<0.05),穿刺时间明显较短(P<0.05),总穿刺次数明显较少(P<0.05),一次穿刺成功率明显较高(P<0.05)。2组总穿刺成功率及并发症发生率比较差异无统计学意义(P>0.05)。结论超声引导锁骨上入路SCV穿刺具有定位时间短、穿刺时间短、穿刺成功率高等优势,值得在颅脑手术中推广应用。

Objective To investigate the application of ultrasound-guided subclavian vein(SCV)puncture via supraclavicular approach in craniocerebral surgery.Methods A total of 80 patients undergoing craniocerebral surgery who needed central venous catheter were selected andrandomly divided into the subclavian approach group(n=40)and the supraclavicular approach group(n=40).The ultrasonic localization time of long axis image of SCV in the two groups were recorded.The vertical distance between the long axis image of SCV and the probe in the two groups were measured.The average inner diameter of SCV in the two groups were measured.The puncture time,total number of puncture,success rate of one puncture and total success rate of puncture in the two groups were recorded.The complications such as accidental puncture of artery and pneumothorax in the two groups were recorded.Results Compared with the subclavian approach group,the ultrasonic localization time of long axis image of SCV was shorter in the supraclavicular approach group(P<0.05),the vertical distance between the long axis image of SCV and the probe was shorter(P<0.05),the average inner diameter of SCV was significantly longer(P<0.05),the puncture time was significantly shorter(P<0.05),the total number of puncture was significantly less(P<0.05),the success rate of one puncture was significantly higher(P<0.05).There was no significant difference in the total success rate of puncture and complication rate between the two groups(P>0.05).Conclusion Ultrasound-guided subclavian vein puncture via supraclavicular approach has the advantages of short localization time,short puncture time and high success rate of puncture,which is worthy of popularization and application in craniocerebral surgery.