| 摘要: |
| 目的 和传统的体表解剖标志定位法相比，探讨超声预定位方法在ICU住院医师颈内静脉置管术中的应用价值。方法 来自西安交通大学第一附属医院重症医学科的12名住院医师，分为2组，对照组(利用传统的体表解剖标志定位法进行颈内静脉置管组)6名医师，每人15例患者，超声组(利用超声预定位法进行颈内静脉置管组) 6名医师，每人15例患者；两组共计180例患者。观察并比较180例患者的一般资料及临床特征，比较两组住院医师的颈内静脉置管成功率、置管时间、第一针穿刺成功率、主治医师操作率以及并发症的发生率。结果 两组患者的基线资料(年龄、性别、体重指数、APACHEII评分、凝血功能及困难置管因素等)一致。超声组颈内静脉置管成功率及第一针穿刺成功率显著高于对照组，100% vs 92.22%，P<0.05； 87.78% vs 70.00%，P<0.05。超声组颈内静脉置管时间及主治医师操作率均低于对照组，9.44±2.27 vs 10.56±4.03，P<0.05；2.22% vs 12.22%，P<0.05。超声组置管并发症显著低于对照组，4.44% vs 21.11%，P<0.05；进一步亚组分析显示，超声组误穿动脉发生率显著低于对照组，3.33% vs 13.33%，P<0.05，而其他并发症如局部血肿、气胸、导管相关性血流感染的发生率，两组无统计学差异。结论 和传统的体表解剖标志定位法相比，应用超声预定位方法可以明显增加ICU住院医师颈内静脉置管术的成功率，缩短置管时间，降低主治医师操作率，同时减少置管并发症的发生率，具有一定的优势。建议对ICU住院医师普遍开展超预定位方法指导颈内静脉置管。 |
| 关键词: 重症监护病房 住院医师 颈内静脉穿刺置管术 超声 并发症 |
| DOI： |
| 投稿时间：2017-06-02修订日期：2017-06-12 |
| 基金项目:西安交通大学第一附属医院院级教学改革研究项目，项目编号：17YB01 |
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| The Application Value of Pre-procedure Ultrasound in the Process of Inter Jugular Venous Catheterization Among ICU Residents |
| lihao,shiqindong |
| (The Application Value of Pre-procedure Ultrasound in the Process of Inter Jugular Venous Catheterization Among ICU Residents) |
| Abstract: |
| Objective To investigate the application value of pre-procedure ultrasound in the process of inter jugular venous catheterization among ICU residents. Methods A total of 12 ICU residents from the First Affiliated Hospital of Xi’an Jiaotong University were involved into this study and divided into two groups: control group (n=6, 15 patients per resident and each patient was treated under inter jugular venous catheterization by the guide of traditional landmark)，ultrasound group (n=6, 15 patients per resident and each patient was treated under inter jugular venous catheterization by the guide of pre-procedure ultrasound). There were 180 patients involved in this study. Investigate and compare the baseline data and clinical characteristic of the two groups. The successful insertion rate, insertion time, first attempt successful cannulation rate, attending physician operation rate and the complication rate in both groups were compared. Results There was no statistically difference in baseline data and clinical characteristics, including age, gender, body index, APACHEII score, coaugulation function and difficult insertion factors, between two groups. The successful insertion rate and first attempt successful cannulation rate in ultrasound group were significantly higher than that in control group, 100% vs 92.22%, P<0.05； 87.78% vs 70.00%, P<0.05. Furthermore, the insertion time and attending physician operation rate in ultrasound group were remarkably lower than that in control group, 9.44±2.27 vs 10.56±4.03, P<0.05; 2.22% vs 12.22%, P<0.05. The complication rate (arterial puncture) in ultrasound group was significantly lower than control group, 3.33% vs 13.33%, P<0.05. There was no difference in other complication rate, including local hematoma, pneumothorax, and catheter related blood infection rate, between two groups. Conclusion These results indicated that, in comparision with traditional landmark guide method, application of pre-procedure ultrasound in the process of inter jugular venous catheterization among ICU residents, can significantly increase the successful insertion rate and first attempt successful cannulation rate, decrease the insertion time, attending physician operation rate and complication rate, which is superior to traditional landmark guide method. It suggested that, during the process of inter jugular venous catheterization among ICU residents, pre-procedure should be used as a routine guide method. |
| Key words: Intensive care unit Residents Inter jugular venous catheterization Ultrasound Complication rate |
