颈内静脉穿刺置管术术前彩色多普勒超声定位和术后超声监测的研究

目的:评估彩色多普勒超声监测颈内静脉置管术的临床价值。方法:应用彩色多普勒超声实时监测120例患者的置管过程,对临床"盲穿"不成功的25例患者及"盲穿"后出现并发症的30例患者进行超声检查分析。结果:120例经实时超声监测的患者均取得成功,没有出现严重的并发症;临床盲穿不成功的原因有误穿颈总动脉、颈内静脉瓣膜过长、误穿颈外静脉、穿入颈内静脉或锁骨下静脉的对侧壁致使导丝不能下移;"盲穿"后出现的并发症主要为血肿、导管堵塞、胸锁乳突肌肿胀、静脉血栓形成、胸腔积血、误穿动脉、假性动脉瘤形成、导管周围纤维鞘膜形成等。结论:超声定位有助于顺利完成颈内静脉穿刺置管,并且对颈内静脉穿刺的各种并发症能够作出准确的诊断。

Prelim Inary Study on the Role of Ultrasound Localization of Internal Jugular Vein Catheterization and the Monitoring Duing the Operation

Objective： To discuss the clinical value of the ultrasound localization of internal jugular vein Catheterization.Materials and methods： 120 cases of internal jugular vein catheterization were guided by ultrasound.25 cases failed and 20 cases with complications following blind puncture were all checked by ultrasound. Results： 120 cases with ultrasound guidance were all successful. Reasons for failure cases with blind method include catheter in common carotid artery, too long valve of internal jugular vein, catheter in external jugular vein, guide wire cannot move down because it is on the other side of the vein. Complications following blind puncture include： Hematoma, occlusion of catheter, swelling of sternocleidomastoid muscle, venous thrombosis, hemothorax, pseudoaneurysm, fiber sheath formation beside the catheter, conclusions： The ultrasound localization can warrant the success of puncture. It also plays an important role in diagnosis of the end of the catheter on the right place between right atrium and superior vena cava.