摘要
目的探讨超声在颈内静脉入路的带隧道带涤纶套中心静脉导管尖端定位中的应用价值。方法纳入西北大学附属医院·西安市第三医院肾脏内科2022年2月至2023年7月收治的拟行颈内静脉带隧道带涤纶套中心静脉导管置入的慢性肾衰竭患者。将上述患者随机分为超声定位组(超声组)和对照组,超声组术中采用超声定位导管尖端,对照组根据术前胸部X线进行定位导管尖端。术后对两组患者进行胸部CT检查来判定导管尖端位置。收集两组人口学资料、相关临床指标及手术操作中相关指标进行统计分析,研究两种不同定位方式在导管置入过程中对导管尖端准确性判断是否存在差异。结果共有42例患者纳入分析,其中年龄、性别、体重指数、原发病、置管史及实验室指标在两组间均差异无统计学意义(P>0.05),导管尖端异位率、穿刺时间、穿刺并发症在两组间均差异有统计学意义(P<0.05)。超声组导管尖端异位率13.1%(3/23)明显低于对照组47.4%(9/19)(χ^(2)=4.443,P=0.035),超声组穿刺时间(5.17±0.83)min明显低于对照组穿刺时间(6.26±0.73)min(t=-4.44,P=0.01),超声组穿刺并发症4.3%(1/23)明显少于对照组穿刺并发症36.8%(7/19)(χ^(2)=5.17,P=0.023)。结论超声在颈内静脉置入带隧道带涤纶套中心静脉导管的过程中,不仅可以引导血管的穿刺,而且对导管尖端位置的定位具有很高的参考价值。
Objective To evaluate the value of ultrasound in tip location of tunnel-cuffed central venous catheter through internal jugular vein.Methods From February 2022 to July 2023,42 patients of chronic renal failure and uremia were admitted for internal jugular vein tunnel insertion with cuff central venous catheter.They were randomized into two groups of ultrasound and control.Tip of catheter was lo-cated by ultrasound during operation in ultrasound group and tip of catheter by chest radiograph in control group.Postoperative chest computed tomography(CT)was performed in both groups to determine the tip of catheter.Demographic data,clinical laboratory tests and intraoperative parameters were recorded for ex-amining the differential accuracy of catheter tip between two methods.Results No significant inter-group differences existed in age,gender,body mass index(BMI),primary disease,history of catheterization or laboratory tests(P>0.05).And significant inter-group differences existed in ectopic rate of catheter tip,puncture time and puncture complications(P<0.05).Ectopic rate of catheter tip was significantly lower in ultrasound group than that in control group[(13.1%,3/23)vs(47.3%,9/19)](χ^(2)=4.443,P=0.035).Puncture time was significantly shorter in ultrasound group than that in control group[(5.17±0.83)vs(6.26±0.73)min](t=-4.44,P=0.01).The complications were significantly fewer in ultrasound group than those in con-trol group[(4.3%,1/23)vs(36.8%,7/19)](χ^(2)=5.17,P=0.023).Conclusion Ultrasound can not only guide the puncture of internal jugular vein,but also locate the tip of central venous catheters with a high refer-ence value.
作者
史井波
刘绥军
祝宇星
高祎
Shi Jing-bo;Liu Sui-jun;Zhu Yu-xing;Gao Yi(Department of Nephrology,Affiliated Third Municipal Hospital,Northwest University,Xi’an 710000,China)
出处
《临床肾脏病杂志》
2024年第5期393-398,共6页
Journal Of Clinical Nephrology
