摘要
目的评估在病房行中心静脉（颈内静脉、锁骨下静脉和股静脉）穿刺置管术的优缺点，成功率和并发症，旨在针对具体患者时能选择合适的穿刺方法。方法回顾性总结在病房行深静脉穿刺中心静脉置管术（颈内静脉、锁骨下静脉和股静脉置管术）862例，记录首次成功率，2次成功率，失败率，并发症（气胸，误入动脉，穿刺口渗漏等）的发生情况。结果862例患者，行右锁骨下静脉穿刺置管术517例，成功494例，失败23例，其中穿到锁骨下动脉2l例，2例发生气胸，失败后改右颈内静脉或股静脉置管术均获成功。右颈内静脉穿刺置管术231例，成功213例，失败18例，其中误入颈内动脉24例，失败后改右锁骨下静脉或股静脉置管术均获成功。股静脉（左、右侧）置管术114例，成功111例，失败3例，其中穿到股动脉16例，失败后改右颈静脉或右锁骨下静脉置管术均获成功。结论选择哪种穿刺置管方法，应根据自身掌握的穿刺技能，熟练程度，结合患者的病情及医疗要求，穿刺条件，穿刺环境，选择最优的穿刺置管途径。一般情况下优先选择右侧锁骨下静脉，其次右侧颈内静脉，最后选择股静脉。
Objective To assess advantages, disadvantages, success rate, and complication of central venous （internal jugular vein, subclavian vein and femoral vein） catheter which was performed in wards, and locate an appropriate method for the patients. Methods A retrospective summary was conducted on the 862 cases of central venous catheter which performed in wards. The followings were included for the summary - success rate of first catheter, success rate of catheter twice, failure rate, a puncture completion time, catheter completion time and the occurrence of complications （hemopneumothorax, strayed into the artery, nerve damage, air embolism, cardiac arrhythmia and puncture leakage）. Results Of 862 patients there were 517 cases which were performed right subclavian vein catheterization, including 494 successful cases and 23 failures. In the 23 failures, 21 of them were strayed into the subclavian artery and 2 pneumothorax. In 231 cases which was performed right internal jugular vein catheterization, there were 213 successful cases and 18 cases of failure. 24 of them were strayed into the right internal carotid artery. In 114 cases which were performed right internal jugular vein catheterization, there were 111 successful cases and 3 cases of failure. 16 cases were strayed into the femoral artery. All failed catheter cases were diverted to other central venous and succeeded. Conclusion Selection of an appropriate catheterization approach is circumstantial, considering operator＇ s acquired skills, proficiency, operating conditions, environment, and combined with patient＇s condition and medical requirements. In general, the very first option is right subclavian vein, followed by the right internal jugular vein, and the femoral vein.
出处
《中国急救复苏与灾害医学杂志》
2015年第12期1162-1164,共3页
China Journal of Emergency Resuscitation and Disaster Medicine
关键词
颈内静脉
锁骨下静脉
股静脉
置管术
病房
Internal jugular vein
Subclavian vein
Femoral vein
Catheterization
Ward
