[急诊床旁超声引导下中心静脉置管的可行性研究]

[A study on feasibility of emergency bedside ultrasound-guided central venous catheterization].

作者信息

Tiegang Li, Nana Wang, Min Zhao

出版信息

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2015 Sep;27(9):724-8.

Abstract

OBJECTIVE

To evaluate the feasibility and clinical significance of emergency bedside ultrasound-guided central venous catheterization performed by emergency department doctors.

METHODS

The clinical data of 216 patients, who underwent central venous catheterization in the Department of Emergency of Shengjing Hospital of China Medical University from January 2009 to June 2014 were retrospectively analyzed. All the patients received femoral vein puncture or internal jugular vein catheterization. The patients were divided into three groups according to the method of catheterization: 72 patients received emergency ultrasound-guided central venous catheterization by emergency doctors independently were assigned as A group, 72 patients underwent catheterization by emergency doctors after being demarcated by ultrasound doctors served as B group, and 72 patients who underwent catheterization method guided by traditional landmark served as C group. Success rate, time spent for catheterization, number of attempts for intubation, and incidence of complications were compared among three groups.

RESULTS

As compared with that of groups B and C, a higher success rate [98.61% (71/72) vs. 83.33% (60/72), 73.61% (53/72), both P < 0.01] was found in group A, also with a shorter successful time for insertion of the catheter (minutes: 5.5 ± 2.5 vs. 9.6 ± 3.7, 16.6 ± 7.2, both P < 0.05), less frequency of the catheter insertion (times: 1.0 ± 0.0 vs. 1.8 ± 0.7, 2.7 ± 2.6, both P < 0.05), and lower incidence of changing puncture site due to insert failure [1.4% (1/72) vs. 8.3% (6/72), 20.8% (15/72), both P < 0.05], lower incidence of mechanical and infective complication [15.3% (11/72) vs. 41.7% (30/72), 59.7% (43/72), both P < 0.05], and also lower catheterization related infection risk [13.9% (10/72) vs. 15.3% (11/72), 12.5% (9/72), both P > 0.05].

CONCLUSION

Emergency bedside ultrasound-guided catheterization resulted in higher success rate and less related complication, therefore it can be recommended for widely application in emergency department treatment.

摘要

目的

评估急诊科医生进行急诊床旁超声引导下中心静脉置管的可行性及临床意义。

方法

回顾性分析2009年1月至2014年6月在中国医科大学附属盛京医院急诊科接受中心静脉置管的216例患者的临床资料。所有患者均接受股静脉穿刺或颈内静脉置管。根据置管方法将患者分为三组：72例由急诊医生独立进行急诊超声引导下中心静脉置管的患者为A组，72例在超声医生划定穿刺点后由急诊医生进行置管的患者为B组，72例采用传统体表标志引导置管方法的患者为C组。比较三组的成功率、置管时间、插管尝试次数及并发症发生率。

结果

与B组和C组相比A组成功率更高[98.61%（71/72）vs. 83.33%（60/72），73.61%（53/72），P均<0.01]，置管成功时间更短（分钟：5.5±2.5 vs. 9.6±3.7，16.6±7.2，P均<0.05），插管次数更少（次数：1.0±0.0 vs. 1.8±0.7，2.7±2.6，P均<0.05），因插管失败而更换穿刺部位的发生率更低[1.4%（1/72）vs. 8.3%（6/72），20.8%（15/72），P均<0.05]，机械性和感染性并发症发生率更低[15.3%（11/72）vs. 41.7%（30/72），59.7%（43/72），P均<0.05]，且置管相关感染风险更低[13.9%（10/72）vs. 15.3%（11/72），12.5%（9/72），P均>0.05]。