超声动态法不同轴平面引导在颈内静脉置管术中的临床应用

Clinical application of dynamic ultrasound guided by different axial planes in internal jugular vein catheterization

目的:比较短轴平面与长轴平面超声引导下颈内静脉穿刺置管的临床效果,探讨最佳的穿刺引导平面在临床应用。方法:选择符合标准的患者180例,年龄45~75岁,按前瞻性随机试验方法分为短轴平面组和长轴平面组,每组各90例。在超声引导下分别使用短轴与长轴平面引导穿刺,记录并比较两组成功刺入目标血管时间、总穿刺时间、一针穿刺成功率、误穿动脉例数。结果:两组均完成超声引导下颈内静脉穿刺置管,短轴平面组刺入目标血管时间为(40.3±10.5)s,长轴平面组为(50.1±12.7)s;总穿刺时间方面(305±30.5)s,长轴平面组为(383.1±13.5)s;一针穿刺成功率,短轴平面组为98%,长轴平面组95%。在误穿动脉,短轴平面组为2例,长轴平面组5例。短轴平面明显优于长轴平面技术。两组均为发生气胸和血胸并发症。结论:与长轴平面技术比较,短轴平面技术引导更适合于在临床应用,并发症更少,是安全有效穿刺置管技术。

Objective To compare the clinical effects of ultrasound-guided internal jugular vein catheterization in short axis plane and long axis plane,and to explore the best puncture guidance plane in clinical application.Method 180 patients,aged 45~75 years,who met the criteria in our hospital were selected and divided into short axis plane group and long axis plane group according to the prospective randomized trial method.There were 90 cases of short axis plane and 90 cases of long axis plane.Under the guidance of ultrasound,the puncture was guided by short axis plane and long axis plane.The time of successful puncture into the target vessel,the total puncture time,the success rate of one needle puncture,and the number of cases of artery puncture by mistake were recorded.Results Both groups completed ultrasound-guided internal jugular vein puncture and catheterization.The puncture time of short axis plane group was(40.3±10.5) seconds in short axis group and(50.1±12.7) seconds in long axis group.And the total puncture time was(305±30.5) seconds in long axis group and(383.1±13.5) seconds.The success rate of one needle puncture was 98% in short axis group and 95% in long axis group.There were 2 cases in short a xis group and 5 cases in long axis group.The short axis plane technology was obviously superior to the long axis plane technology.Pneumothorax and hemothorax complications occurred in both groups.Conclusion Compared with the long axis plane technique,the short axis plane technique is more suitable for clinical application with less complications.It is a safe and effective puncture and catheter placement technique.