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目的:研究Ambesh手法结合导丝抽拉动作在锁骨下静脉置管(SVC)中防止导管误入同侧颈内静脉的效果。方法:采用Ambesh手法结合导丝抽拉动作对2009年11月-2010年10月共274例患者实施SVC,以2008年11月-2009年10月的227例常规操作病例作为对照组,研究单侧置管到位率及导管误入同侧颈内静脉的情况。结果:单侧置管到位率试验组为95.99%,对照组为90.75%,经χ2检验差异有统计学意义(P<0.05);误入同侧颈内静脉的发生率试验组为1.46%,对照组为7.05%,两组差异统计学意义(P<0.05);试验组中,单侧到位率意识清醒组为97.18%,意识障碍组为91.8%,两组单侧到位率经校正χ2检验差异无统计学意义(P>0.05);导管误入率意识清醒组为0.47%,意识障碍组为4.92%,经fisher确切概率法检验,差异有统计学意义(P<0.05)。结论:Ambesh手法结合导丝抽拉动作可有效减少SVC过程中导管误入同侧颈内静脉的机会,增加置管到位率。
OBJECTIVE: To study the effect of Ambesh technique combined with guide wire drawing action in preventing the catheter from entering the ipsilateral jugular vein in subclavian vein catheterization (SVC). Methods: A total of 274 patients with SVC were treated with Ambesh technique combined with guidewire pull-out in November 2009-October 2010. A total of 227 routine operation cases from November 2008 to October 2009 were selected as the control group. Lateral tube placement rate and catheter into the ipsilateral jugular vein. Results: The single-side catheterization rate was 95.99% in the trial group and 90.75% in the control group, and the difference was statistically significant by χ2 test (P <0.05). The incidence of ipsilateral jugular vein was 1.46% The control group was 7.05%, the difference between the two groups was statistically significant (P <0.05). In the experimental group, the rate of one-sided awareness was 97.18% in conscious group and 91.8% in disturbance of consciousness group. There was no significant difference between the two groups (P> 0.05). The percentage of false positives in catheterization was 0.47% in conscious conscious group and 4.92% in conscious disorder group. The Fisher exact test showed significant difference (P <0.05). Conclusion: Ambesh technique combined with guide wire pull-out can effectively reduce the chances of catheter infiltration into the ipsilateral jugular vein during SVC and increase the rate of catheterization.