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-  2015 

非经典体位下超声引导颈内静脉困难穿刺的临床应用价值 Application of Ultrasound-Guided Internal Jugular Vein Catheterization in a Non-Classical Position

Keywords: 非经典体位,超声引导,颈内静脉穿刺

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Abstract:

目的:探讨非经典体位下超声引导颈内静脉困难穿刺的临床应用价值。方法:回顾性分析武汉大学人民医院2010-2012年非经典体位(非Trendelenberg体位)颈内静脉困难穿刺患者40例,除5例不能平卧患者直接行超声引导穿刺,35例患者行常规穿刺(A组,n=35)。常规穿刺失败行超声引导穿刺者28例(B组,n=33)。比较两组穿刺成功率(一次成功率和总成功率)、穿刺次数、并发症率(误穿动脉)、穿刺所花费时间。两种体位下颈内静脉与颈总动脉毗邻关系的百分比及比较。结果:A组7例直接穿刺成功,13例误穿颈总动脉,其余15例穿刺失败,28例均改用超声引导穿刺。B组穿刺成功30例,3例失败。A组一次成功率5.7%,总成功率20.0%,穿刺次数4.1±1.7,并发症率37.1%,B组一次成功率63.6%,总成功率90.9%,穿刺次数1.3±0.4,并发症率3.0%(P<0.05或P<0.01)。A组颈内静脉位于颈总动脉前外侧的患者(45.7%)显著高于B组(15.2%)。A组颈内静脉位于颈总动脉前的患者(25.7%)显著低于B组(42.4%)。结论:对于非经典体位下颈内静脉困难穿刺患者,超声引导穿刺优势明显,可降低操作难度,提高成功率,降低并发症

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