内科

目的总结右颈内静脉穿刺置管的经验，探讨超声引导下右颈内静脉穿刺置管在血液透析中的应用价值。方法回顾性分析535例使用传统盲穿、超声定位及超声引导三种方法行右颈内静脉穿刺置管术成功率、穿刺时间、病人满意度和发生并发症的种类和例数。结果传统盲穿218例中，一次成功103例（47.25%），穿刺时间（65±11）s，总成功率83.01%（181例），发生局部气肿、血肿17例（7.80%），误伤颈动脉9例（4.29%），神经损伤3例（1.38%），血气胸1例（0.46%），病人满意度54.13%；超声定位210例中，一次成功121例（57.62%），穿刺时间（45±8）s，总成功率91.43%（192例），发生局部气肿、血肿12例（5.71%），误伤颈动脉4例（1.90%），神经损伤1例（0.48%），无血胸、气胸病例，病人满意度77.62%；超声引导107例，一次成功92例（85.98%），穿刺时间（30±7）s，总成功率100%，除1例发生局部皮下血肿外，未发生其他并发症，病人满意度达82.22%。与传统盲穿比较，超声定位，尤其超声引导穿刺有很大的优越性。结论血液透析患者行右颈内静脉穿刺置管，是一种风险较大的有创性操作，在超声引导下穿刺能缩短操作时间，提高成功率，减少并发症，提高病人满意度。

ObjectiveSummarizing the experience of right internal jugular vein catheterization,to investigate the clinical application of ultrasound in right internal jugular vein catheterization during hemodialysis.MethodClinical data of 535 hemodialysis patients receiving right internal jugular vein catheterization were retrospectively analyzed, three methods were used in the catheterization including blind catheterization, ultrasonic positioning and ultrasonic guidance.Success rate,puncture time,patient satisfaction and the types and case numbers of complications were counted as well.ResultsThere were 218 cases of routine blind catheterization,among them,103 cases were one-time success (47.25%), puncture time was 65±11 seconds,rate of success was 83.01%(181cases),local haematoma or emphysema occurred in 17cases(7.80%),carotid arterial mis-placement in 9cases(4.29%),nerve injury in 3 cases (1.38%), blood chest pneumothorax 1 cases (0.46%),patient satisfaction was 54.13%;Ultrasound-localized catheterization was conduct in 210 patients,121cases were one-time success (57.62%),puncture time was 45±8 seconds,rate of success was 91.43% (192 cases), local emphysema or hematoma in12 cases (5.71%),carotid arterial mis-placement in 4 cases (1.90%),and nerve damage 1 cases (0.48%),and with no blood chest and pneumothorax,patient satisfaction was 77.62%;107 cases were guided by ultrasound,92 cases were one-time success(85.98%),puncture time 30±7 seconds and rate of success was 100%,except emphysema occurred in 1 case,no complications occurred,patient satisfaction was 82.22%.Compared with routine blind catheterization,ultrasonic positioning,especially guided by ultrasound has great advantage.ConclusionRight internal jugular vein catheterization is a high-risk traumatic procedure.Correct methods and ultrasound assistance can effectively shorten operating time,reduce complications,improve success rate and patient satisfaction.