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目的探讨超声引导在危重症患者中心静脉穿刺置管中的应用效果。方法采用前瞻性随机对照临床研究方法,选择需行中心静脉穿刺置管的危重症患者200例,将患者随机分为穿刺引导组(观察组)和体表标志定位组(对照组),每组100例。其中对照组男性63例,女性37例;平均年龄64岁,平均体质量69.3 kg。观察组男性54例,女性46例;平均年龄58岁,平均体质量71.0 kg。对照组根据体表解剖标志定位穿刺部位和进针角度。观察组在超声引导下穿刺置管。记录两组一次性穿刺成功例数、总穿刺次数、操作时间和失败例数;统计两组误穿动脉、出血、局部血肿、气胸、导管相关性感染等穿刺并发症发生率。结果与对照组比较,观察组通过超声引导能提高中心静脉穿刺置管的一次性穿刺成功率、减少总穿刺次数、降低穿刺失败率(P<0.05),观察组操作时间较长(P<0.05)。同时,观察组误穿动脉、出血和局部血肿的发生率明显降低(P<0.05),两组患者气胸和导管相关性感染发生率差异无统计学意义。结论超声引导下中心静脉穿刺置管术能够实现“可视化”操作,避免盲目穿刺给患者带来的危害,帮助医务人员进一步提高一次性穿刺成功率、减少总穿刺次数、降低穿刺并发症发生率。
Objective To explore the application of ultrasound guided central venous catheterization in critically ill patients. Methods A prospective randomized controlled clinical study was conducted in 200 cases of critically ill patients undergoing central venous catheterization. The patients were randomly divided into a puncture guide group (observation group) and a body surface marker localization group (control group), and each group 100 cases. The control group of 63 males and 37 females; average age 64 years, average body mass 69.3 kg. The observation group of 54 males and 46 females; mean age 58 years, average body weight 71.0 kg. The control group according to body surface anatomical landmark positioning puncture site and needle angle. The observation group under the guidance of ultrasound catheterization. The number of successful punctures, the total number of punctures, the operation time and the number of failed cases were recorded. The incidences of puncture complications such as arterial, hemorrhage, local hematoma, pneumothorax and catheter-related infections were recorded. Results Compared with the control group, the ultrasound guided group in the observation group could improve the success rate of one-time puncture of central venous catheterization, reduce the total number of punctures, decrease the puncture failure rate (P <0.05), and prolong the operation time in the observation group (P <0.05 ). At the same time, the incidence of mistaking artery, hemorrhage and local hematoma in the observation group was significantly lower (P <0.05). There was no significant difference in the incidence of pneumothorax and catheter-related infection between the two groups. Conclusions Ultrasound-guided central venous catheterization can achieve “visualization ” operation to avoid the harm of blind puncture to patients, to help medical staff to further improve the success rate of one-time puncture, reduce the total number of punctures and reduce the incidence of puncture complications rate.