Hájek J, Chovanec V, Chytrý P, Merglová I, Hanousková P, Pilař M, Kašová S, Lerchová J, Krajina A
Pardubická krajská nemocnice, a.s., Pardubice.
Rozhl Chir. 2012 Dec;91(12):660-5.
The aim of our study was to evaluate the influence of ultrasonographic and fluoroscopic navigation on the rate of procedural and early complications during central venous cannulation.
We retrospectively evaluated procedural and early complications in patients who had undergone central venous cannulation under sonographic and fluoroscopic control within a two year period (from January 2010 to December 2011). We studied procedural and early complications (within 24 hours after the procedure). We summarized all cases of pneumothorax, haemothorax and haematoma of soft tissue larger than 5 cm in long axis, and other severe complications e.g. ardiac arrhythmias or hypotension. The set of patients indicated for central venous cannulation included mainly oncological patients who were implanted central venous port systems, and a small group of patients who were cannulated either at the intensive care unit (ICU) or at the department of anesthesiology after unsuccessful blind cannulation. There were three patients cannulated because of transjugular liver biopsy.
We cannulated 165 patients under sonographic control within two years. There were 66 men, the mean age of 58.6 years (20-82) and 99 women, the mean age of 58.3 years (36- 94). We cannulated internal jugular vein 148 times and subclavian vein 17 times. The primary technical success was 100% in our study group. Totally, we had 6 complications (3.6%). Immediatelly after the procedure we observed two pneumothoraxes (1.2%) which did not require chest drainage. We punctured artery wall three times, but without haematoma developement, and after a ten-minute commpression, all procedures were successfully finished. We had serious vagal reaction during the cannulation in one patient. We had no fatal procedural complication in our group. There are significantly fewer complications using jugular approach compared to subclavian one.
We conclude that the ultrasonographic central venous cannulation is a very safe method with a low risk of procedural and early complications. There were significantly fewer complications in case of jugular cannulation compared to subclavian approach in our group of patients. Ultrasonographically navigated central venous cannulation should be used more fequently in emergency medicine as well as in case of non-acute central venous cannulation performed a tan intensive care unit or by anesthesiologists.
我们研究的目的是评估超声和透视引导对中心静脉置管过程中操作及早期并发症发生率的影响。
我们回顾性评估了在两年期间（2010年1月至2011年12月）在超声和透视引导下接受中心静脉置管的患者的操作及早期并发症情况。我们研究了操作及早期并发症（术后24小时内）。我们总结了所有气胸、血胸以及长轴大于5厘米的软组织血肿病例，以及其他严重并发症，如心律失常或低血压。拟进行中心静脉置管的患者主要包括植入中心静脉端口系统的肿瘤患者，以及一小部分在重症监护病房（ICU）或麻醉科经盲目置管失败后进行置管的患者。有3例患者因经颈静脉肝活检而进行置管。
两年内在超声引导下我们为165例患者进行了置管。其中男性66例，平均年龄58.6岁（20 - 82岁），女性99例，平均年龄58.3岁（36 - 94岁）。我们对颈内静脉进行了148次置管，对锁骨下静脉进行了17次置管。我们研究组的初次技术成功率为100%。总体而言，我们有6例并发症（3.6%）。术后立即观察到2例气胸（1.2%），无需进行胸腔引流。我们3次穿刺到动脉壁，但未形成血肿，经过10分钟压迫后，所有操作均成功完成。1例患者在置管过程中出现严重迷走神经反应。我们组没有致命的操作并发症。与锁骨下途径相比，采用颈内静脉途径的并发症明显更少。
我们得出结论，超声引导下的中心静脉置管是一种非常安全的方法，操作及早期并发症风险低。在我们的患者组中，与锁骨下途径相比，颈内静脉置管的并发症明显更少。超声引导下的中心静脉置管在急诊医学以及在重症监护病房或由麻醉医生进行的非急性中心静脉置管情况下应更频繁地使用。
