患者 男性,28岁,因急性水肿型胰腺炎收入院治疗,入院后决定行左锁骨下静脉穿刺置管;穿刺前胸片无异常。取平卧位、头转向右侧,左肩胛稍垫高使肩后展,使用德国产的中心静脉穿刺套针及导管,于左锁骨中点内侧1cm锁骨下进针,点胸廓平面成15°朝同侧胸锁关节后方向入针6cm,顺利回抽出静脉血,退出针蕊,插入导管6cm后遇阻力,稍用力插管后阻力消失,导管顺利插入15cm并固定,补液通畅,病人无不适。置管后4小时病人开始气促、心悸。体查:R30次/分,紫绀,气管右侧移位,左肋间增宽、饱满,左胸廓语颤减弱,叩诊实音,呼吸音消失。即复胸平片示左胸大量积液。行左胸腔穿刺抽 Male patient, 28 years old, was admitted to hospital for acute edematous pancreatitis. After admission, his left subclavian vein catheterization was decided. The chest X-ray was normal before puncture. Take the supine position, the head turned to the right, slightly raised left shoulder scapula to shoulder after the show, the use of German-made central venous puncture trocar and catheter, the middle of the left midpoint of the left clavicle 1cm into the needle under the subclavian point of the plane into the chest 15 ° Toward the same side of the sternoclavicular joint into the needle 6cm, successfully withdrawn venous blood, exit the needle core, inserted into the catheter 6cm after resistance encountered a little forced intubation resistance disappeared, the catheter smoothly inserted 15cm and fixed, fluid replacement, the patient without discomfort . 4 hours after catheterization, the patient started to have shortness of breath and palpitations. Physical examination: R30 beats / min, cyanosis, the right tracheal shift, the left intercostal widening, full, weakened left thorax tremor, percussion real sound, breath sounds disappear. Chest radiograph showed a lot of left chest fluid. Line left chest puncture pumping