胸前区体表定位腋静脉穿刺置管临床研究

刘仁杰; 常双喜; 闫圣杰; 邢伟

doi:10.13201/j.issn.1009-5918.2020.10.008

胸前区体表定位腋静脉穿刺置管临床研究

- 郑州市第一人民医院呼吸与危重症医学科(郑州, 450004)

详细信息

通讯作者: 刘仁杰,E-mail:liurenjie2010@126.com

中图分类号: R631.4

收稿日期: 2020-07-27

Clinical study on positioning axillary vein catheterization in anterior thoracic region

- Department of Pulmonary and Critical Care Medicine, Zhengzhou First People's Hospital, Zhengzhou, 450004, China

More Information

Corresponding author: LIU Ren-jie, E-mail: liurenjie2010@126.com

Received Date: 27 July 2020

摘要

摘要: 目的:探讨胸前区体表定位腋静脉穿刺置管方法的安全性和可行性,为临床提供更多深静脉穿刺的选择。方法:收集2017-03-2019-12期间我院呼吸与危重症医学科(RICU)行中心静脉穿刺置管的126例患者,根据不同的穿刺置管方法分为A组(42例,胸前区体表定位腋静脉穿刺)、B组(44例,锁骨下静脉穿刺)和C组(40例,颈内静脉穿刺),分别比较一次穿刺成功率,二次穿刺成功率,三次穿刺成功率,穿刺总成功率,穿刺过程中并发症发生率,对可行性和安全性进行比较。结果:A组一次穿刺成功18例(42.86%),二次穿刺成功12例(28.57%),三次穿刺成功7例(16.67%),穿刺失败5例,穿刺总成功37例(88.10%);B组一次穿刺成功21例(47.73%),二次穿刺成功15例(34.09%),三次穿刺成功5例(11.36%),穿刺失败3例,穿刺总成功41例(93.18%);C组一次穿刺成功20例(50.00%),二次穿刺成功14例(35.00%),三次穿刺成功4例(10.00%),穿刺失败2例,穿刺总成功38例(95.00%);3组间比较一次穿刺成功率(χ²=0.442,P=0.813)、二次穿刺成功率(χ²=0.578,P=0.790)、三次穿刺成功率(χ²=0.930,P=0.633)、穿刺总成功率(χ²=1.453,P=0.506)差异均无统计学意义。A组误穿动脉、气胸、导管异位分别为2例(4.76%)、0和1例(2.38%);B组误穿动脉、气胸、导管异位分别为4例(9.09%)、2例(4.55%)、2例(4.55%);C组误穿动脉、气胸、导管异位分别为4例(10.00%)、2例(5.00%)和0。3组间比较误穿动脉发生率(χ²=0.893,P=0.710)、气胸发生率(χ²=2.080,P=0.464)、导管异位发生率(χ²=1.863,P=0.773)差异均无统计学意义。结论:熟练掌握胸前区解剖结构,应用胸前区体表标志定位法行经腋静脉穿刺置管术是安全可行的。其具有操作容易、成功率高、安全性好、并发症少等优点,对于危重患者有很高的临床应用价值,值得临床推广。
- 深静脉穿刺 /
- 腋静脉穿刺 /
- 锁骨下静脉穿刺 /
- 颈内静脉穿刺
Abstract: Objective:In order to provide more clinical choices for deep venipuncture, the safety and feasibility of body surface positioning axillary venipuncture catheterization in anterior thoracic region were discussed. Method:The central vein catheterization of axillary venipuncture was performed by locating the body surface markers in the chest area. A total of 126 cases of central venipuncture and catheterization of RICU via axillary vein, subclavian vein and internal jugular vein in our hospital from March 2017 to December 2019 were collected. Divided into axillary venipuncture group A(42 patients), subclavian venipuncture group B(44 patients), and internal jugular venipuncture group C(40 patients), the success rate of the first puncture, the success rate of the second puncture, the success rate of the third puncture, the total success rate of the puncture, the incidence of complications during the puncture, and the safety were compared. Result:In group A, 18 patients(42.86%) were successful in one puncture, 12 patients(28.57%) in the second puncture, 7 patients(16.67%) in the third puncture, 5 patients(88.10%) in the third puncture, and 37 patients(88.10%) in the total. In group B, there were 21 patients(47.73%) who succeeded in the first puncture, 15 patients(34.09%) who succeeded in the second puncture, 5 patients(11.36%) who succeeded in the third puncture, and 3 patients(93.18%) who failed in the third puncture. In group C, there were 20 patients(50.00%) with one puncture success, 14 patients(35.00%) with two puncture success, 4 patients(10.00%) with three puncture success, 2 patients with puncture failure, and 38 patients(95.00%) with total puncture success. There was no statistically significant difference between the three groups in the success rate of primary puncture(χ²=0.442, P=0.813), the success rate of secondary puncture(χ²=0.578, P=0.790), the success rate of tertiary puncture(χ²=0.930, P=0.633), and the total success rate of puncture(χ²=1.453, P=0.506). Two patients(4.76%), 0 and 1 patient(2.38%) were in group A with malocclusion of artery, pneumothorax and catheter respectively. In group B, 4 patients(9.09%), 2 patients(4.55%) and 2 patients(4.55%) were mistakenly perforated with ectopic pneumothorax and catheter, respectively. In group C, 4(10.00%), 2(5.00%), and 0 were treated with malocclusion of artery, pneumothorax, and catheter, respectively. There was no significant difference between the three groups in the incidence of artery mispassage(χ²=0.893, P=0.710), the incidence of pneumothorax(χ²=2.080, P=0.464) and the incidence of catheter ectopic(χ²=1.863, P=0.773).Conclusion:It is safe and feasible to perform tranaxillary venipuncture and catheterization by locating body surface markers in the thoracic region. Tranthoracic axillary vein puncture catheterization is easy to operate, high success rate, good safety, fewer complications, good patient compliance, convenient nursing, it has a high clinical value for critical patients, worthy of clinical promotion.
- deep vein puncture /
- axillary vein puncture /
- subclavian vein puncture /
- internal jugular vein puncture

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