摘要
目的探讨特殊患者在B超引导下穿刺锁骨下静脉的可行性、安全性及成功率,并与传统盲穿法锁骨下静脉穿刺置入中心静脉导管进行比较。方法 40例拟行胃癌、肺癌(其中包括肥胖、胸廓畸形、恶液质)等较大手术患者以及恶性肿瘤化疗后晚期(血小板计数<30×109/L)等住院患者,根据不同方式的穿刺,随机分为实验组(A组)和对照组(B组)各20例。A组:锁骨下静脉穿刺是在B超引导下进行并置管;B组:锁骨下静脉穿刺是按传统方法盲穿并置管。结果在B超引导下行锁骨下静脉穿刺成功率提高、并发症减少,更加安全:A组穿刺成功率显著高于B组(P<0.05);两种方法锁骨下静脉穿刺置管并发症比较,A组并发症显著少于B组(P<0.05)。结论 B超引导锁骨下静脉穿刺置管术简单、直观、安全,置管成功率高,尤其对于那些如恶性肿瘤化疗后血小板低、肥胖、胸廓畸形、恶液质患者,可减少置管失败和穿刺并发症的发生,对提高临床救治质量、降低医疗风险具有较高应用价值。
Objective To explore the feasibility, safety and successful rate of B ultrasound-led subclavian vein puncture, and to compare it with traditional subclavian vein puncture into central venous catheter via blinding puncture. Methods all 40 patients proposed to be given larger surgeries of gastric cancer and lung cancer （including obesity, chest deformity, cachexia） and hospitalized patients in advanced stage （platelet count 〈30x109/L） after chemotherapy for malignant tumor were selected. They were randomly assigned to the experiment group（group A） and control group （group B） according to different types of puncture, with 20 patients in each group; group A： subclavian vein puncture was led by B ultrasound and catheterization was performed; group B： subclavian vein puncture was conducted via the traditional method of blind punctur.e and catheterization was performed. Results The successful rate of subclavian vein puncture led by B ultrasound was higher, complications were fewer and the safety was better： （1）the successful rate of puncture in group A was higher than that in group B （P〈0.05）; （2） in the comparison of complications induced by subclavian vein puncture and catheterization between the two methods, the complications in group A were significantly fewer than those in group B （P〈0.05）. Conclusion B ultrasound-led subclavian vein puncture is easy, straightforward, safe and has higher successful rate of catheterization, especially for the patients with low platelet count, obesity, chest deformity and cachexia after the chemotherapy for malignant tumors. This method is able to reduce the incidence of catheterization failure and complications of puncture, which is of high application value of improving clinical treatment quality and reducing medical risks.
出处
《中国现代医生》
2016年第14期78-80,共3页
China Modern Doctor
基金
江西省新余市科技局指导性项目(20143090840)
关键词
B超引导
盲穿
锁骨下静脉
穿刺置管术
特殊患者
B ultrasound-led
Blind puncture
Subclavian vein puncture
Catheterization
Special patients
