摘要
目的探讨改良的锁骨下静脉穿刺方法行锁骨下静脉穿刺,减少血胸、气胸和血气胸的发生。方法选择100例行射频消融的患者,应用改良的锁骨下静脉穿刺方法穿刺的患者做为观察组;100例应用传统的锁骨下静脉穿刺方法植入永久起搏器的患者为对照组,观察穿刺成功率和并发症的发生率。改良的锁骨下静脉穿刺方法：X线正位透视下距锁骨和第一肋的交界处外下方约1个穿刺针的距离进针,与皮肤成15~30度夹角。结果观察组穿刺成功97例,成功率97%,其中3例透视下穿刺未成功,经股静脉送指引导丝至腋静脉,导丝指引下穿刺成功,成功穿刺部位在X线正位透视下锁骨和第一肋交界处第一肋上缘以下、第二肋上缘以上约2~3cm2的范围内;3例穿刺未成功;3例曾误穿锁骨下动脉,手法压迫后无出血;1例误穿刺锁骨下动脉并置入5F鞘管,保留导丝拔除鞘管后压迫5min无出血,随后拔除导丝。对照组穿刺成功98例,成功率98%,2例改经透视下穿刺腋静脉成功;误穿锁骨下动脉6例,1例发生血气胸,其余5例手法压迫后无出血;气胸2例。观察组患者血胸、气胸或血气胸的发生率低于对照组（0vs 3%,P〈0.01）。结论改良的锁骨下静脉穿刺是一种安全的穿刺方法,无血胸、气胸和血气胸的发生。
Objective To explore a new subclavian vein puncture method in order to reduce the incidence rate of pneumothorax,hemothorax and hemopneumothorax. Methods One hundred patients received radiofrequency ablation by new subclavian vein puncture as observation group and another 100 patients accepted traditional subclavian vein puncture as control group.The success rate of puncture and the occurrence of complication were observed in all patients.The method of new subclavian vein puncture：X-Ray postero-anterior position guided puncture at the outer lower side of the junction between the clavicle and the first rib,of which the distance is about 18 Gpuncture needle,and with 15-30 degree angle with the skin. Results One hundred patients was included,puncture success in 97 cases,success rate was 97%,and 3cases punctured successfully under X-Ray with guide wire advanced to the axillary vein through the femoral vein.The successfully puncture site was at the junction between the clavicle and the first rib,about 2-3square centimeter.Three cases puncture failed,three cases punctured the subclavian artery,no bleeding after compression,one case punctured the subclavian artery and implanted a 5Fsheath and no bleeding after compression.In the control group,98 cases punctured successfully,the success rate was 98%.Two cases punctured axillary vein successfully under X-ray.Six cases punctured the subclavian artery,no bleeding after compression in five cases,one case suffered hemopneumothorax;Two cases suffered pneumothorax. Conclusion The newsubclavian vein puncture method is safe,simple and feasible,there is no complication of pneumothorax,hemothorax and hemopneumothorax.
出处
《中国心脏起搏与心电生理杂志》
2016年第6期536-538,共3页
Chinese Journal of Cardiac Pacing and Electrophysiology
