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目的比较术前彩色超声定位和实时彩色超声引导以及盲穿法在血液透析患者中心静脉置管中的差异,评价其实际应用价值。方法选取2014年1月1日至2015年1月1日在郑州大学第一附属医院血液净化中心需要采取中心静脉置管作为临时透析通路的患者300例,将其随机分配到三组:传统的盲穿法(A组)、实时彩色超声引导法(B组)以及术前彩色超声定位法(C组)。终点事件为试穿次数大于5次或穿刺入动脉大于2次或导丝置入困难大于2次,并发症包括刺破动脉、血肿形成、气胸、血胸等。利用SPSS 16.0软件对各组测量指标进行统计学分析。结果 (1)术前彩色超声定位法的失败率几乎同实时彩色超声引导一致(3%vs.1%,P>0.05),而远低于传统盲穿法(3%vs.15%,P<0.05)。(2)术前彩色超声定位法的第一次试穿失败率与实时彩色超声引导法接近(6%vs.1%,P>0.05),而远低于盲穿法(6%vs.35%,P<0.05)。(3)术前彩色超声定位法的总体并发症与实时彩色超声引导法接近(5%vs.1%,P>0.05),与盲穿法也无统计学差异(5%vs.10%,P>0.05)。(4)成功置管所需的试穿次数比较,术前彩色超声定位法与实时彩色超声引导法差异不具有统计学意义(1.19±0.14 vs.1.13±0.11,P>0.05);在所需手术时间上,两者差异不具有统计学意义[(21.34±0.25)min vs.(19.22±0.17)min,P>0.05]。结论血液透析患者进行中心静脉置管采取术前彩色超声定位法,在置管成功率、第一次试穿成功率以及所需试穿次数方面均优于传统盲穿法,而与实时彩色超声引导法相差无几,可作为实时彩色超声引导法的第二选择。
Objective To compare the difference of central venous catheterization in hemodialysis patients by color sonography, real-time color ultrasound guidance and blind wear before operation, and to evaluate its practical value. Methods From January 1, 2014 to January 1, 2015, 300 patients who needed central venous catheterization as the temporary dialysis access were enrolled in the Blood Purification Center of the First Affiliated Hospital of Zhengzhou University. They were randomly assigned to three groups: traditional Blind method (group A), real-time color ultrasound guided method (group B) and preoperative color ultrasound localization method (group C). End-point events for the trial more than 5 times or more than 2 times the puncture into the artery or wire insertion difficulties more than 2 times, complications include puncturing the artery, hematoma formation, pneumothorax, hemothorax and so on. Using SPSS 16.0 software for statistical analysis of each group of measurement indicators. Results (1) The failure rate of preoperative color sonography was almost the same as that of real-time color ultrasound guidance (3% vs.1%, P> 0.05), but much lower than that of the conventional blind method (3% vs.15%, P <0.05). (2) The first failure rate of preoperative color ultrasound localization was close to that of real-time color ultrasound guidance (6% vs.1%, P> 0.05), but much lower than that of blind penetration (6% vs.35 %, P <0.05). (3) The overall complication of preoperative color ultrasound localization method was close to that of real-time color ultrasound guided method (5% vs.1%, P> 0.05) P> 0.05). (4) Compared with the number of try-on times for successful catheterization, there was no significant difference between preoperative color ultrasound localization method and real-time color ultrasound guidance method (1.19 ± 0.14 vs.1.13 ± 0.11, P> 0.05) There was no significant difference between the two groups in the operation time [(21.34 ± 0.25) min vs. (19.22 ± 0.17) min, P> 0.05). Conclusion Hemodialysis patients with central venous catheterization preoperative color ultrasound localization method, the success rate of catheterization, the success rate of the first try-on and the number of trials required are better than the traditional blind method, and real-time color ultrasound Guidance method is almost the same, can be used as the second choice of real-time color ultrasound guidance method.