超声引导与盲穿行中心静脉置管的临床效果比较

黄磊; 第加美; 邹宝; 段秉慧; 刘智; 张超学

doi:10.16766/j.cnki.issn.1674-4152.001955

超声引导与盲穿行中心静脉置管的临床效果比较

doi: 10.16766/j.cnki.issn.1674-4152.001955

黄磊¹,
第加美²,
邹宝¹,
段秉慧¹,
刘智²,
张超学^3, ,

1.
安徽理工大学第一附属医院淮南市第一人民医院超声科，安徽淮南 232000
2.
安徽理工大学第一附属医院淮南市第一人民医院肾内科，安徽淮南 232000
3.
安徽医科大学第一附属医院超声科，安徽合肥 230022

基金项目:

安徽高校自然科学研究项目 KJ2019A0095

详细信息

通讯作者:
张超学，E-mail: zcxay@163.com

中图分类号: R445.1 R459.5
计量
- 文章访问数: 151
- HTML全文浏览量: 60
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2020-04-26
- 网络出版日期: 2022-02-16

Retrospective analysis of ultrasound-guided and blind central vein catheterisation

1.
Department of Ultrasound, the First Affiliated Hospital of Anhui University of Technology, Huainan, Anhui 232000, China

摘要

摘要: 目的回顾性分析超声引导与传统盲穿在不同部位行中心静脉置管的疗效比较。方法选择从2017年3月—2020年3月在安徽理工大学第一附属医院暨淮南市第一人民医院肾内科住院的肾衰竭患者共117例，按置管方式不同分为超声引导组与盲穿组, 再根据置管静脉的不同将超声引导组分为颈静脉置管组与股静脉置管组, 最后根据超声引导下颈静脉的进针方式不同分为颈静脉平面内中位组与颈静脉平面外低位组，分别比较超声引导组与盲穿组、超声引导下颈静脉置管组与股静脉置管组及超声引导下颈静脉平面内中位组与平面外低位组的穿刺时间、置管时间、穿刺与置管成功率、并发症及置管后透析血流量的情况。结果超声引导组中患者年龄高于盲穿组, 差异有统计学意义(P < 0.05)，而穿刺时间、穿刺成功率明显优于盲穿组，且超声引导组并发症的发生率(3.45%)显著低于盲穿组(18.33%)，差异有统计学意义(均P < 0.05)；超声引导下颈静脉置管组穿刺时间明显比股静脉置管组短(P < 0.05)，穿刺和置管成功率差异无统计学意义；超声引导下颈静脉平面外低位组置管时间与血流量明显优于超声引导下颈静脉平面内中位组(P < 0.05)。结论超声引导下中心静脉置管与传统盲穿比较穿刺及置管时间短且穿刺成功率高，并发症少，安全性更高，超声引导下颈静脉平面外置管可以有效地减低血容量不足率，值得在临床中推广。
- 中心静脉 /
- 置管 /
- 超声引导 /
- 盲穿
Abstract: Objective Retrospective analysis of the effect of ultrasound guidance and traditional blind puncture in different regions of central venous catheterisation. Methods A total of 117 patients with renal failure who were hospitalised in the Department of Nephrology of the First Affiliated Hospital of Anhui University of Technology and Hainan First People's Hospital from March 2017 to March 2020 were selected and divided into ultrasound guided and blind puncture groups by catheterisation method. The ultrasound-guidedgroup was then divided into Cervical vein catheterization group and femoral vein catheterization group, components were the jugular vein catheterisation and femoral vein catheterisation groups, which were finally divided into internal plane median group and out- plane low group of jugular vein by ultrasound-guided jugular vein insertion method. Incidence of complications and dialysis blood flow after catheterisation and puncture time, catheterisation time and puncture and catheterisation success rates were compared between the ultrasound guided group and blind puncture group in the blind puncture; ultrasound-guided jugular vein catheterisation; femoral vein catheterisation and ultrasound-guided jugular vein in-plane median and out-of-plane low group groups were considered. Results The age range of the patients in the ultrasound-guided group was significantly higher than that in the blind-puncture group (P < 0.05). Puncture time and puncture success rate in the ultrasound-guided group were significantly higher than those in the blind-puncture group. The incidence of complications in the ultrasound-guided group (3.45%) was significantly lower than the blind puncture group (18.33%), and the difference was statistically significant (all P < 0.05). Puncture time in the ultrasound-guided jugular vein catheterisation group was significantly shorter than that in the femoral vein catheterisation group (P < 0.05). No significant differences in the success rates of puncture and catheterisation were observed. Catheterisation time and blood flow in the ultrasonograph-guided jugular vein out-of-plane low-position group were significantly better than those in the ultrasound-guided jugular vein-in-plane median group (P < 0.05). Conclusion Compared with traditional blind puncture, ultrasound-guided central venous catheterisation has shorter puncture and catheterisation times, higher puncture success rate and fewer complications and is safer. An ultrasound-guided jugular vein out-of-plane catheter can effectively reduce the rate of insufficient blood volume and is thus worth promoting in clinics.
- Peripherally inserted central catheter /
- Ultrasound guidance /
- Blind puncture /

HTML全文

图 1 超声引导下静脉穿刺置管

注：A为平面外进针，针尖抵达颈静脉前壁形成凹陷；B为平面外进针，穿刺针快速突破颈静脉管壁，进入静脉内，可见一点状强回声；C为平面内进针，可清晰的显示穿刺针，呈一线状强回声，针尖抵达静脉前壁形成凹陷；D为平面内进针，穿刺针快速突破静脉管壁，进入静脉内，可见一条状强回声；E为股静脉穿刺进针，清晰显示针道；F为股静脉穿刺进针，可清晰的显示穿刺针，呈一线状强回声，进入静脉内；G为导丝进入中心静脉内，呈一线型强回声；H为透析管进入中心静脉内，呈“=”强回声)。

下载: 全尺寸图片幻灯片

表 1 超声引导组与盲穿组结果的比较(x ±s)

组别	例数	年龄(岁)	BMI	穿刺时间(s)	置管时间(s)	置管成功[例(%)]	并发症[例(%)]
超声引导组	58	61.8±13.5	22.6±3.1	48.0±11.9	148.7±15.6	58(98.30)	2(3.45)
盲穿组	60	54.2±16.3	23.3±2.8	60.9±8.0	154.2±16.2	59(98.33)	11(18.33)
统计量		2.816^a	-1.332^a	-6.927^a	-1.861^a
P值		0.006	0.185	< 0.001	0.065	0.999^b	0.012^b
注：^a为t值，^b为采用Fisher精确检验。

下载: 导出CSV

表 2 颈静脉组与股静脉组结果的比较[例(%)]

组别	例数	穿刺时间(x ±s，s)	穿刺成功率(%)	置管时间(x ±s，s)	置管成功	并发症
颈静脉组	33	40.2±7.7	100.00	145.8±14.2	33(100.00)	0(0.00)
股静脉组	26	58.0±8.4	100.00	152.5±16.9	25(96.15)	2(7.69)
统计量		-8.510^a		-1.642^a	1.290^b	2.630^b
P值		< 0.001		0.106	0.256	0.105
注：^a为t值，^b为χ²值。

下载: 导出CSV

表 3 平面内中位组与平面外低位组结果的比较(x ±s)

组别	例数	穿刺时间(s)	置管时间(s)	透析中血流量(mL/min)
平面内中位组	11	42.7±8.8	153.7±13.9	185.5±15.7
平面外低位组	22	38.9±6.9	141.8±12.9	199.5±15.6
t值		1.381	2.430	-2.442
P值		0.177	0.021	0.020

下载: 导出CSV

参考文献(15)

[1]	叶朝阳, 陈冬平. 血液透析常用血管通路的选择与维护[J]. 中华肾病研究电子杂志, 2018, 7(2): 55-58. https://www.cnki.com.cn/Article/CJFDTOTAL-SHSB201802002.htm
[2]	范天琼, 朱金陵, 闵丽霞, 等. 彩超引导与体表解剖标志定位在中心静脉置管术中的应用效果比较[J]. 西南军医, 2017, 19(5): 450-452. doi: 10.3969/j.issn.1672-7193.2017.05.018
[3]	胡文江, 魏云, 郑瑞莲. 超声引导下放置临时双腔血液透析导管在尿毒症患者治疗中的回顾分析[J]. 影像研究与医学应用, 2019, 3(2): 73-74. doi: 10.3969/j.issn.2096-3807.2019.02.048
[4]	吕大志. 彩超引导下中心静脉穿刺置管的临床应用[J]. 世界最新医学信息文摘, 2016, 16(41): 129. doi: 10.3969/j.issn.1671-3141.2016.41.100
[5]	缴宝杰, 王东尼, 齐曼曼, 等. 超声引导下22G套管针辅助新生儿颈内静脉穿刺术[J]. 局解手术学杂志, 2019, 28(3): 246-249. https://www.cnki.com.cn/Article/CJFDTOTAL-JJXZ201903019.htm
[6]	MARTINS MARROCOS M S, S GENTIL T M, DE C LIMA F, et al. Reasons of unsuccessful implantation of short-term hemodialysis catheters in jugular veins using real-time ultrasound[J]. J Vasc Access, 2018, 19(5): 467-472. doi: 10.1177/1129729818759259
[7]	LALU M M, FAYAD A, AHMED O, et al. Ultrasound-guided subclavian vein catheterization: a systematic review and meta-analysis[J]. Crit Care Med, 2015, 43(7): 1498-1507. doi: 10.1097/CCM.0000000000000973
[8]	李志莲, 余永森, 杨莉, 等. 中心静脉置管术后静脉血栓形成的超声诊断及相关因素分析[J]. 中华诊断学电子杂志, 2017, 5(3): 179-182. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDDZ201703011.htm
[9]	王琪, 万虹, 许伟英, 等. 彩超高频探头下经外周静脉穿刺中心静脉置管的临床应用[J]. 医疗装备, 2019, 32(13): 150-152. doi: 10.3969/j.issn.1002-2376.2019.13.090
[10]	崔婷婷, 周国庆, 陈东升, 等. 不同角度B超引导下斜面内法颈静脉置管在肠癌化疗患者中的应用[J]. 中国肿瘤临床与康复, 2019, 26(1): 50-53. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZK201901021.htm
[11]	席春生, 刘冬梅, 关怀, 等. 不同的超声引导方式对颈内静脉血透导管置管术的影响[J]. 中国现代医学杂志, 2015, 25(6): 98-100. doi: 10.3969/j.issn.1005-8982.2015.06.022
[12]	王伟, 陶然, 何显炬, 等. 超声定位下颈内静脉置管在急危重症肾功能衰竭患者血液净化治疗中的临床应用[J]. 现代医院, 2014, 14(12): 37-39. doi: 10.3969/j.issn.1671-332X.2014.12.015
[13]	夏明清, 孙玲. 高流量血液透析对尿毒症维持性血液透析患者血清溶质的清除效果[J]. 中国医学前沿杂志, 2019, 11(1): 114-117. https://www.cnki.com.cn/Article/CJFDTOTAL-YXQY201901023.htm
[14]	张跃男, 白云娟, 王晓媛. 不同血液净化方式对维持性血液透析患者残余肾功能的影响[J]. 中国医药导报, 2015, 12(12): 156-159. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201512040.htm
[15]	万绪波, 蒋薇, 黄洋峰. 严重创伤患者不同部位中心静脉置管的应用选择[J]. 医学信息, 2017, 30(1): 103-105.