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目的探讨实时超声引导在早产儿脐静脉置管术的应用价值。方法通过对需进行脐静脉置管的60例早产儿进行实时超声引导脐静脉置管,置管前应用高频探头测量引导路径各段的长度,估算导管插入长度,置管术中根据超声测值预判导管顶端置于脐静脉肝内段时开始进行实时超声引导,缓慢引导导管顶端通过门静脉左支囊部、静脉导管到达下腔静脉内,而未进入右心房内,回抽血顺利,固定导管后,超声扫查再次确认导管顶端置于下腔静脉内,引导结束。结果60例研究对象中脐静脉置管一次性置管成功率达93.3%(56/60);术前超声测量引导路径预判导管插入深度(7.70±0.72)cm,实际置管深度(7.59±1.20)cm,差异无统计学意义(P=0.574)。结论实时超声引导下脐静脉置管的一次性置管成功率高,具有很好的导航作用,且可明确置管失败的原因;术前应用超声检查可观察置管路径各段的情况,且术前超声测量引导路径预判导管插入深度可给实际置管提供参考。
Objective To explore the value of real-time ultrasound guided umbilical vein catheterization in premature infants. Methods Sixty cases of premature infants who needed umbilical vein catheterization were instructed to perform real-time ultrasound guided umbilical vein catheterization. Before catheterization, the length of the guiding path was measured with a high-frequency probe to estimate the catheterization length. The value of the preconditioned catheter tip placed in the intrahepatic segment of umbilical vein started real-time ultrasound guidance, slowly guide the top of the catheter through the left branch of the portal vein, venous catheter to reach the inferior vena cava, and did not enter the right atrium, drawing blood smoothly, After fixing the catheter, the ultrasound scan reconfirms that the catheter tip is placed in the inferior vena cava, and the guidance ends. Results The success rate of catheterization of umbilical vein in 60 cases was 93.3% (56/60). The diameter of catheter insertion was 7.70 ± 0.72 cm preoperatively and the actual catheter depth was 7.59 ± 1.20) cm, the difference was not statistically significant (P = 0.574). Conclusion The real-time ultrasound-guided umbilical vein catheterization has a high success rate of one-time catheterization, which has good navigation effect and can clearly cause the failure of catheterization. Preoperative ultrasound examination can observe the various stages of the catheterization path, and Preoperative ultrasonic measurement guide path to predict the depth of catheter insertion can provide a reference for the actual catheterization.