Mey U, Glasmacher A, Hahn C, Gorschlüter M, Ziske C, Mergelsberg M, Sauerbruch T, Schmidt-Wolf I G H
Medizinische Klinik und Poliklinik I der Rheinischen Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany.
Support Care Cancer. 2003 Mar;11(3):148-55. doi: 10.1007/s00520-002-0399-3. Epub 2002 Oct 23.
Ultrasound guidance for percutaneous puncture of the internal jugular vein provides many advantages over the classic landmark-guided technique, particularly in complicated cases (e.g. thrombocytopenia, obesity, dyspnea). The present prospective investigation involved analysis of 493 punctures and provides patient- and operator-dependent variables with respect to the impact on puncture success and the complication rate. These 493 punctures of the internal jugular vein were performed using identical puncturing equipment and a standardized two-operator catheterization technique and were prospectively recorded on the hematology-oncology ward of a university hospital. Alongside success rates, the frequency and nature of complications, patient-inherent risk variables (obesity, thrombocytopenia, patient cooperation, vein diameter, etc.) and the individual experience of the physician performing the puncture and ultrasound were analyzed with respect to possible impact on success and complication rate. Internal jugular vein cannulation was successful in 94.5% of all patients. Catheter placement was successful at the first attempt in 87.6% of cases. Arterial fail punctures occurred in 1.4% of the patients and local hematoma in a further 4.3%. Among the patient-dependent variables, only poor patient compliance and a maximum vein diameter smaller than 7 mm showed a negative influence on the success rate. The experience of the physician carrying out the puncture influenced neither the success rate nor the complication rate. In contrast, both failure and complication rates were significantly lower when the physician guiding the sonographic probe was familiar with the method. Ultrasound-guided cannulation of the internal jugular vein provides safe central venous access with high success rates and low complication rates. Difficulties due to patient-inherent risk factors (e.g. thrombocytopenia, obesity, dyspnea) can be managed well using ultrasonographic guidance. The success rate achieved and the frequency of complications are decisively influenced not by the experience of the physician performing the puncture, but by the experience of the physician acting as sonographer.
与传统的体表标志引导技术相比，超声引导下经皮穿刺颈内静脉具有诸多优势，尤其是在复杂病例中（如血小板减少症、肥胖、呼吸困难）。本前瞻性研究对493次穿刺进行了分析，并提供了与患者和操作者相关的变量，以探讨其对穿刺成功率和并发症发生率的影响。这493次颈内静脉穿刺均使用相同的穿刺设备和标准化的双操作者置管技术，并在一所大学医院的血液肿瘤病房进行了前瞻性记录。除成功率外，还分析了并发症的发生频率和性质、患者自身的风险变量（肥胖、血小板减少症、患者配合情况、静脉直径等）以及进行穿刺和超声检查的医生的个人经验，以探讨其对成功率和并发症发生率的可能影响。所有患者中，94.5%的颈内静脉置管成功。87.6%的病例首次尝试导管置入即成功。1.4%的患者发生动脉穿刺失败，另有4.3%发生局部血肿。在患者相关变量中，只有患者依从性差和最大静脉直径小于7 mm对成功率有负面影响。进行穿刺的医生的经验对成功率和并发症发生率均无影响。相比之下，当超声探头引导医生熟悉该方法时，失败率和并发症发生率均显著降低。超声引导下颈内静脉置管可提供安全且成功率高、并发症发生率低的中心静脉通路。对于由患者自身风险因素（如血小板减少症、肥胖、呼吸困难）导致的困难，使用超声引导可得到很好的解决。穿刺成功率和并发症发生频率并非决定性地受穿刺医生的经验影响，而是受超声检查医生的经验影响。
