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目的探讨抢救大面积烧伤休克期儿童更为有效、安全的穿刺补液途径,从而提高其抢救成功率、减少死亡率及并发症的新方法。方法 90例≤6岁大面积烧伤休克期患儿,按穿刺途径随机分为A、B、C三组,各30例。A组给予经锁骨小切迹定位行颈内静脉穿刺置管,B组给予中路颈内静脉穿刺置管,C组给予锁骨下静脉穿刺置管。对比三组治疗效果。结果 A组总成功率为100%,B组为87%,C组为75%,三组两两比较差异有统计学意义(P<0.05);A组一次穿刺成功率为93%,B组为73%,C组为47%,三组两两比较差异有统计学意义(P<0.05);从定位到顺利置入导管所需时间A组平均(180±50)s,B组平均(360±30)s,C组平均(660±60)s,三组两两比较差异有统计学意义(P<0.05)。A组无并发症出现,B组误穿动脉2例、局部血肿1列,C组误穿动脉3例,三组两两比较差异无统计学意义(P>0.05)。结论经锁骨小切迹定位行颈内静脉穿刺置管抢救大面积烧伤休克期儿童有安全度高、创伤少、穿刺成功率高、并发症少等优点,有明显实用价值。
Objective To explore a more effective and safe method of puncture and rehydration in children with burn shock in large area, so as to improve the success rate of rescue and reduce the mortality and complications. Methods Totally 90 children aged ≤6 years with severe burn shock were randomly divided into three groups (A, B and C), 30 cases in each group. Group A was given the location of the small clavicle through the internal jugular vein catheterization, B group given middle jugular vein puncture catheter, C group given subclavian vein catheterization. Comparison of three groups of treatment. Results The total success rate of group A was 100%, group B was 87%, group C was 75%, the difference between the two groups was statistically significant (P <0.05) (P <0.05). The average time from positioning to catheterization was (180 ± 50) s in group A, while the average in group B 360 ± 30) s, and the average of C group was (660 ± 60) s. There was a significant difference between the two groups (P <0.05). There were no complications in group A, 2 cases in group B were mistakenly penetrated by artery, 1 in local hematoma, 3 cases were mistakenly interrupted in group C, there was no significant difference between the two groups (P> 0.05). Conclusion The small clapboard positioning of the jugular vein catheterization in the rescue of large area burn shock children with high safety, less trauma, high puncture success rate, fewer complications, has obvious practical value.