超声引导下右侧颈内静脉穿刺术在肾衰竭患者血液透析中应用研究

Application of ultrasound-guided right internal jugular vein puncture for hemodialysis in patients with renal failure

目的探讨超声引导下右侧颈内静脉穿刺术在肾衰竭患者血液透析中应用价值。方法随机选择116例肾衰竭患者,其中男性79例,女性37例;年龄35～62岁,平均年龄54.54岁。根据不同穿刺方法分为对照组(58例)和观察组(58例)。对照组男性39例,女性19例;年龄35～62岁,平均年龄53.43岁。观察组男性40例,女性18例;年龄36～61岁,平均年龄54.86岁。对照组采用盲法定位法,观察组采用超声引导穿刺,比较两组患者置管情况(术中穿刺置管成功率、置管时间和置管成功率)。比较两组置管感染情况、舒适度评分和并发症发生情况。结果观察组第1次穿刺成功率明显高于对照组(97%vs 71%;χ~2=12.889,P <0.01),置管时间短于对照组[(7.16±0.99) min vs (11.75±1.54) min](t=19.094, P <0.01)。对照组术后感染患者多于观察组(6.9%vs 1.7%;χ~2=5.902,P <0.05)。对照组误伤颈动脉6例,神经损伤4例,局部血管气肿5例,血胸、气胸4例;观察组局部血管气肿1例。对照组发生误伤颈动脉、神经损伤和血胸、气胸发生率显著高于观察组(χ~2=6.327、4.143、4.143,P <0.05)。对照组舒适度评分显著低于观察组[(66.43±6.43)分vs (84.32±8.43)分](t=-12.851,P <0.05)。结论在肾衰竭患者血液透析中采用超声引导下右侧颈内静脉穿刺术可提高置管成功率,减少感染和并发症发生,具有高的临床应用价值。

Objective To investigate the value of ultrasound-guided right internal jugular vein puncture for hemodialysis in patients with renal failure. Methods A total of 116 patients with renal failure were enrolled, which included 79 males and 37 females, aged 35-62 years old with mean age of 54.54 years old. According to different puncture methods, all of them were divided into control group(n = 58, which included 39 males and 19 females;aged 35-62 years old with mean age of 53.43 years old) and observation group(n = 58, which included 40 males and 18 females;aged 36-61 years old with mean age of 54.86 years old). Patients in control group were performed blind location and observation group performed ultrasound-guided puncture. The intraoperative puncture catheter success rate, catheterization time, catheter success rate, catheter infections, comfort scores, and complications between 2 groups were compared. Results In observation group, the success rate of the first puncture was higher than that of control group(97 % vs 71 %;χ~2= 12.889, P < 0.01), and catheterization time was shorter than that of control group[(7.16 ± 0.99) minutes vs(11.75 ± 1.54) minutes](t = 19.094, P < 0.01). The postoperative infections in control group was higher than that in observation group(6.9 % vs 1.7 %;χ~2= 5.902, P < 0.05). In control group, incidental injury for carotid artery was 6 cases, nerve injury for 4, local angiomonia for 5, hemothorax and pneumothorax for 4. While in observation group, there was only 1 case local angiomonia. The incidence of carotid artery, nerve injury and hemothorax and pneumothorax in control group were significantly higher than those in observation group(χ~2= 6.327, 4.143, 4.143, P < 0.05).The comfort rating of control group was significantly lower than that of control group[(66.43 ± 6.43) vs(84.32 ± 8.43)](t =-12.851, P < 0.05). Conclusion It is demonstrated that ultrasound-guided right internal jugular vein puncture used for hemodialysis in patients with renal failure could improve success rate of catheterization, reduce infection and complications,and had high clinical value.