经验丰富的操作人员对超声引导下腋静脉置管的纵向和横向入路的比较。
A comparison of longitudinal and transverse approaches to ultrasound-guided axillary vein cannulation by experienced operators.
作者信息
He Yi-Zhou, Zhong Ming, Wu Wei, Song Jie-Qiong, Zhu Du-Ming
机构信息
Department of Intensive Care Unit, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
出版信息
J Thorac Dis. 2017 Apr;9(4):1133-1139. doi: 10.21037/jtd.2017.03.137.
BACKGROUND
The axillary vein is an easily accessible vessel that can be used for ultrasound-guided central vascular access and offers an alternative to the internal jugular and subclavian veins. The objective of this study was to identify which transducer orientation, longitudinal or transverse, is better for imaging the axillary vein with ultrasound.
METHODS
We analyzed 236 patients who had undergone central venous cannulation of axillary vein in this retrospective study. Patients were divided into two groups, the longitudinal approach group (n=120) and transverse approach group (n=116). Recorded the one-attempt success rate, operation time, arterial puncture rate and pneumothorax rate. We perform chest radiography to confirm pneumothorax on all patients. We compared the one-attempt success rate, operation time, arterial puncture rate and pneumothorax rate between the two groups.
RESULTS
The two groups were comparable with clinical characters of patients. The overall success rates of the longitudinal group and the transverse group were both 100%. The rate of one-attempt success in the longitudinal approach group is higher than the transverse approach group (91.7% 82.8%, P=0.040). The transverse approach group had shorter operation time than the longitudinal group (184.7±8.1 287.5±19.6 seconds, P=0.000). The two groups had lower postoperative complications. Arterial puncture occurred in 1 of 120 longitudinal and 2 of 116 transverse attempts and this difference was no significant (P=0.541). No pneumothorax occurred in the two groups.
CONCLUSIONS
The longitudinal approach during ultrasound-guided axillary vein cannulation is associated with greater one-attempt success rate compared with the transverse approach by experienced operators. The transverse approach has shorter operation time. The two groups have lower postoperative complications and are comparable with pneumothorax and arterial puncture.
背景
腋静脉是一条易于触及的血管，可用于超声引导下的中心血管通路建立，是颈内静脉和锁骨下静脉的替代选择。本研究的目的是确定哪种探头取向（纵向或横向）更有利于超声成像腋静脉。
方法
在这项回顾性研究中，我们分析了236例行腋静脉中心静脉置管的患者。患者分为两组，纵向入路组（n = 120）和横向入路组（n = 116）。记录一次穿刺成功率、操作时间、动脉穿刺率和气胸率。我们对所有患者进行胸部X线检查以确认气胸情况。我们比较了两组之间的一次穿刺成功率、操作时间、动脉穿刺率和气胸率。
结果
两组患者的临床特征具有可比性。纵向组和横向组的总体成功率均为100%。纵向入路组的一次穿刺成功率高于横向入路组（91.7%对82.8%，P = 0.040）。横向入路组的操作时间比纵向组短（184.7±8.1秒对287.5±19.6秒，P = 0.000）。两组术后并发症发生率较低。纵向入路的120次尝试中有1次发生动脉穿刺，横向入路的116次尝试中有2次发生动脉穿刺，差异无统计学意义（P = 0.541）。两组均未发生气胸。
结论
对于有经验的操作者，超声引导下腋静脉置管时纵向入路的一次穿刺成功率高于横向入路。横向入路的操作时间较短。两组术后并发症发生率较低，气胸和动脉穿刺情况相当。
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