床旁超声引导中心静脉置管在低血容量性休克患者中的应用
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摘要
目的:探讨低血容量性休克患者应用床旁超声引导中心静脉置管的临床效果。方法:136例ICU收治的需进行中心静脉置管的低血容量性休克患者,根据置管方式分为床旁超声引导中心静脉置管组(实验组)和Seldinger穿刺法置管组(对照组)。比较两组患者置管时间、穿刺成功率和各类并发症的发生率。结果:实验组置管时间为(7.2±1.8)分,明显短于对照组的(10.6±2.1)分(P<0.05);实验组一次、二次及三次穿刺成功率分别为94.3%、98.6%、100.0%,均明显高于对照组(51.5%、63.6%、72.7%,P <0.05)。实验组局部血肿形成、误穿动脉发生率明显低于对照组(P<0.05)。结论:床旁超声引导中心静脉置管可提高低血容量休克患者置管成功率,并能缩短置管时间、减少并发症,具有良好的应用价值。
Objective: To investigate the clinical effects of bedside ultrasound-guided central venous catheterization in patients with hypovolemic shock. Methods: 136 patients with hypovolemic shock that underwent central venous catheterization in ICU were divided into experimental group(bedside ultrasound-guided central venous catheterization) and control group(Seldinger puncture catheterization) according to catheterization mode. The catheterization time, success rate of puncture and incidence of complications of patients in 2 groups were compared. Results: The catheterization time of patients in experimental group was(7.2±1.8)min, which was obviously shorter than control group(10.6±2.1 min, P<0.05).The first, second and third success rate of puncture of patients in experimental group were respectivley 94.3%, 98.6% and100.0%, which were all obviously higher than control group(P<0.05). The incidence rate of local hematoma formation and mispuncture of artery of patients in experimental group were obviously lower than control group(P<0.05). Conclusions:Bedside ultrasound-guided central venous catheterization can increase the success rate of catheterization of patients with hypovolemic shock, also can shortern catheterization time and reduce complications, so has better application value.
Objective: To investigate the clinical effects of bedside ultrasound-guided central venous catheterization in patients with hypovolemic shock. Methods: 136 patients with hypovolemic shock that underwent central venous catheterization in ICU were divided into experimental group(bedside ultrasound-guided central venous catheterization) and control group(Seldinger puncture catheterization) according to catheterization mode. The catheterization time, success rate of puncture and incidence of complications of patients in 2 groups were compared. Results: The catheterization time of patients in experimental group was(7.2±1.8)min, which was obviously shorter than control group(10.6±2.1 min, P<0.05).The first, second and third success rate of puncture of patients in experimental group were respectivley 94.3%, 98.6% and100.0%, which were all obviously higher than control group(P<0.05). The incidence rate of local hematoma formation and mispuncture of artery of patients in experimental group were obviously lower than control group(P<0.05). Conclusions:Bedside ultrasound-guided central venous catheterization can increase the success rate of catheterization of patients with hypovolemic shock, also can shortern catheterization time and reduce complications, so has better application value.
引文
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[10]张富岚,周静畅.超声引导对经颈内静脉穿刺中心静脉置管成功率的影响[J].临床麻醉学杂志,2013,29(5):514-515.
[11]American Society of Anesthesiologists Task Force on Central Venous Access,Rupp SM,Apfelbaum JL,et al.Practice guidelines for central venous access:a report by the American Society ofAnesthesiologists Task Force on Central Venous Access[J].Anesthesiology,2012,116(3):539-573.
[12]沈鹏,安友仲,齐衍濛,等.超声引导下中心静脉置管在老年复苏患者中的应用[J].中国老年学杂志,2016,36(13):3271-3273.
[13]Karakitsos D,Labropoulos N,De Groot E,et al.Real-time ultrasound-guided catheterization of the internal jugular vein:a prospective comparison with the landmark technique in critical care patients[J].Critical Care,2006,10(6):R162.
[2]中国医师协会急诊医师分会.急诊超声标准操作规范[J].中国急救医学,2013,33(7):577-591.
[3]刘大为.实用重症医学[M].第l版.北京:人民卫生出版社,2010:62-64.
[4]杨伟强,龚好,徐欣晖,等.床旁超声在急诊困难颈内静脉穿刺置管术中的应用价值[J].中国急救医学,2015,35(z2):424-426.
[5]林萍,邓杨.低血容量性休克患者救治中深静脉穿刺置管术的应用[J].吉林医学,2013,34(36):7769.
[6]Calvert N,Hind D,McWilliams RG,et al.The effectiveness and cost-effectiveness of ultrasound locating devices for central venous access:a systematic review and economic evaluation[J].Health Technol Assess,2003,7(12):1-84.
[7]Airapetian N,Maizel J,Langelle F,et al.Ultrasound-guided central venous cannulation is superior to quick-look ultrasound and landmark methods among inexperienced operators:a prospective randomized study[J].Intensive Care Med,2013,39(11):1938-1944.
[8]张碧波,邵杰,李斌,等.超声引导行颈内静脉穿刺置管在创伤失血性休克患者中的应用价值[J].河北医学,2016,22(3):423-424.
[9]Powell JT,Mink JT,Nomura JT,et al.Ultrasound-guidance can reduce adverse events during femoral central venous cannulation[J].JEmerg Med,2014,46(4):519-524.
[10]张富岚,周静畅.超声引导对经颈内静脉穿刺中心静脉置管成功率的影响[J].临床麻醉学杂志,2013,29(5):514-515.
[11]American Society of Anesthesiologists Task Force on Central Venous Access,Rupp SM,Apfelbaum JL,et al.Practice guidelines for central venous access:a report by the American Society ofAnesthesiologists Task Force on Central Venous Access[J].Anesthesiology,2012,116(3):539-573.
[12]沈鹏,安友仲,齐衍濛,等.超声引导下中心静脉置管在老年复苏患者中的应用[J].中国老年学杂志,2016,36(13):3271-3273.
[13]Karakitsos D,Labropoulos N,De Groot E,et al.Real-time ultrasound-guided catheterization of the internal jugular vein:a prospective comparison with the landmark technique in critical care patients[J].Critical Care,2006,10(6):R162.