刘志东+苗卉+陈文慧

[摘要]目的 探讨彩超实时引导半坐卧位颈内静脉穿刺置管术的临床应用价值。方法 选取2014年1月～2015年12月本院收治的70例强迫性半坐卧位危重症患者作为研究对象，按照入院时间顺序分成观察组和对照组，各35例。对照组采用常规静脉穿刺置管术建立静脉通路，观察组采用彩超实时引导半坐卧位颈内静脉穿刺置管术建立静脉通路。比较两组的首次穿刺成功率、二次穿刺成功率、并发症发生率。结果 观察组的首次穿刺成功率、二次穿刺成功率显著高于对照组，差异有统计学意义（P<0.05）。观察组的局部血肿、气胸、神经损伤、心律失常发生率显著低于对照组，差异有统计学意义（P<0.05）。结论 针对半坐卧位体位患者，采取彩超实时引导颈内静脉穿刺置管定位的准确性、成功率均较高，并发症少，临床应用价值显著，值得推广应用。

[关键词]彩色多普勒超声；特殊体位；颈内静脉；穿刺置管；临床价值

[中图分类号] R445.1 [文献标识码] A [文章编号] 1674-4721（2016）06（c）-0042-03

[Abstract]Objective To evaluate the clinical application value of real time color ultrasound guided semirecumbent position jugular vein puncture.Methods 70 patients with compulsive semirecumbent position critically ill from January 2014 to December 2015 in our hospital were selected and divided into the observation group and the control group according to the time sequence of admission，35 cases in each group.The control group was given routine vein catheterization to establish the venous access，and the observation group was received color ultrasound real-time guide semirecumbent position catheterization of the internal jugular vein to establish venous pathway.The success rate of the first puncture and the second puncture，the incidence rate of complication in the two groups was compared.Results The success rate of the first puncture and the second puncture in the observation group was higher than that in the control group，with significant difference （P<0.05）.The incidence rate of local hematoma，pneumothorax，nerve injury and arrhythmia in the observation group was lower than that in the control group，with significant difference （P<0.05）.Conclusion The accuracy and success rate of the positioning of jugular vein catheterization by color ultrasound in real time for semirecumbent position patients is higher，with less complication and obvious application value in clinical.It is worth to promotion and application.

[Key words]Color Doppler ultrasound；Special position；Internal jugular vein；Puncture catheter；Clinical value

颈内静脉穿刺置管是目前临床上应用较广泛的一种基本技术。传统的穿刺方法是以正常人体解剖特点为依据，选择前路、中路、后路，展开盲探式穿入[1]。值得注意的是，由于颈部解剖结构复杂，变异较大，再加上部分患者血管条件不满足要求、颈内静脉紧贴颈动脉等诸多影响因素，在穿刺置管过程中很容易出现并发症、置管失败，给患者带来诸多不利或是严重后果[2]。近年来，随着彩色多普勒超声技术的不断发展和日渐完善，彩超引导下颈内静脉穿刺置管术的临床效果更加理想[3]。本研究选取本院收治的强迫性半坐卧位危重症患者作为研究对象，探讨彩超实时引导半坐卧位颈内静脉穿刺置管术的临床应用价值，旨在为今后的临床诊治工作提供有价值的参考信息。……