摘要
目的:为提高器官移植术患者颈内静脉穿刺置管的成功率及其安全性,减少并发症,应用彩色多普勒超声引导颈内静脉穿刺置管,并与采用传统的体表标志法穿刺者进行对比观察。方法:选择2004-11/2007-04南京医科大学附属无锡第一医院收治,预计穿刺较困难的肝移植及肾移植手术患者70例,根据患者意愿分为彩超定位组和对照组各35例。彩超定位组应用HDI5000型彩色多普勒超声显像仪进行实时立体定位,引导行颈内静脉穿刺置管并定期监控;对照组采用传统的体表标志法定位行颈内静脉穿刺置管。记录穿刺置管时间、成功率和并发症,穿刺置管成功后定期监控置入导管所在血管的血流情况、有无血栓形成或栓塞及飘浮导管的位置是否合适等。结果:70例均进入结果分析。①彩超定位组穿刺置管操作时间少于对照组(P<0.001)。②彩超定位组46次穿刺操作均一次成功,43次经颈内静脉单壁直接穿入,3例次穿过双壁,经稍退针后成功穿入,无一例次发生误穿动脉或其他并发症;对照组45次穿刺中,一次直接成功者20例次,6例次曾误穿入动脉。③21例肝移植患者均成功置入飘浮导管全程行有创心功能监测,术后监测发现4例有早期血栓形成。结论:①将彩色多普勒超声技术用于器官移植术患者颈内静脉穿刺时进行立体定位,引导穿刺置管,可明显提高穿刺置管的成功率和安全性。②通过术后定期监控,可了解导管位置是否保持准确及有无血栓形成等并发症发生。
AIM： To improve the successful rates and security of the puncture of intemal jugular vein in the patients who accept organ transplantation and decrease the complications, the Doppler color ultrasound-guided technique was applied and compared with traditional puncture method. METHODS： From November 2004 to April 2007, 70 patients who accepted liver and kidney transplantation, who may be evaluated difficulty of puncture, were selected from Wuxi First Hospital of Nanjing Medical University, and divided into color ultrasound group and control group with 35 cases in each group. Ultrasound group were subjected to HDI 5000 Doppler color ultrasound scanner to guide the puncture of internal jugular vein and inspection of the complication, while the control group only accepted traditional body surface symbol method for puncture. The puncture and canulation real time, successful rate and complication were recorded, and the following blood flow in the vessel after canulation, the thrombus or embolism and the location of floating tubes were monitored regularly. RESULTS： All 70 cases were involved in the result analysis. ①The puncture real time in ultrasound group was shorter than that in control group （P 〈 0.001 ②GAll the 46 times punctures of patients in ultrasound group, 43 times were through the single wall and 3 times were through double walls of the veins, which was punctured finally after needle withdrawal. The puncture into arteries was not found neither the complications. In the 45 times punctures for control group, there were 20 cases of one-time manipulation success, while jugular arteries were punctures by accident in 6 cases. ③Swan-Ganz floating tubes were successfully embedded in 21 patients who accepted liver transplantation, and their heart function was monitored. Four patients revealed a formation of nonage thrombus in the internal jugular veins. CONCLUSION： ①Doppler color ultrasound-guided technique may distinctly improve the successful rates and security in thepuncture of internal jugular vein for patients after organ transplantation. ②The situation of floating tubes and complications are known by postoperatively monitoring periodically.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第40期8082-8085,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
