超声引导下颈外静脉穿刺在重症监护病房（ICU）严重脓毒症患者中的应用：一项随机试验。

Application of ultrasound-guided external jugular vein puncture in intensive care unit (ICU) patients with severe sepsis: a randomised trial.

机构信息

Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China.

Department of Neurological Intensive Care Unit, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.

出版信息

Ann Palliat Med. 2021 Jan;10(1):530-537. doi: 10.21037/apm-20-2500.

DOI:10.21037/apm-20-2500

PMID:33545784

Abstract

BACKGROUND

Sepsis is one of the most common critical illnesses in intensive care unit (ICU) clinical practice. Intravenous infusion technology is an important method for life support. The commonly used deep vein indwelling is expensive, and the incidence of infection due to long-term placement is high. Ultrasound technology can guide clinical puncture operations in real time and greatly improve the success rate of puncture. In the present study, we aimed to explore the effect of ultrasound-guided external jugular vein puncture and catheterization in patients with sepsis.

METHODS

From December 2018 to December 2019, a total of 61 patients with sepsis from the ICU or neurology care unit (NCU) were included in the present study and were randomly divided into the experimental group (n=30) and control group (n=31). Ultrasound-guided indwelling cannula needle was used in the experimental group, and blind indwelling cannula needle was used in the control group. The success rate of puncture at first operation, indwelling complications (e.g., bleeding, redness, infection, poor infusion), and operation time of the 2 methods were compared.

RESULTS

A comparison of the patients in the control group with the experimental group indicated no significant differences in age, body mass index, sex, temperature, mean aortic pressure, sequential organ failure score, need for vasopressors, central venous pressure, leucocytes, hemoglobin, platelets, albumin, and mechanical ventilation (all P>0.05). The duration of ICU or NCU stay was 5 days in the experimental group compared with 7 days in the control group (P=0.009). Compared with the control group, the experimental group had shorter successful puncture time (4.0 vs. 6.0 min, P<0.001), higher first puncture success rate (93% vs. 71%, Ρ=0.023), and a lower incidence of complications (12.5% vs. 45.0%, P=0.001).

CONCLUSIONS

For patients with sepsis in ICU, ultrasound-guided puncture is superior to blind manual puncture.

摘要

背景

脓毒症是重症监护病房（ICU）临床实践中最常见的危重病之一。静脉输液技术是一种重要的生命支持方法。常用的深静脉留置针价格昂贵，且长期放置感染发生率高。超声技术可以实时引导临床穿刺操作，大大提高穿刺成功率。本研究旨在探讨超声引导下颈外静脉穿刺置管术在脓毒症患者中的应用效果。

方法

本研究纳入 2018 年 12 月至 2019 年 12 月 ICU 或神经重症监护病房（NCU）的 61 例脓毒症患者，随机分为实验组（n=30）和对照组（n=31）。实验组采用超声引导留置套管针，对照组采用盲法留置套管针。比较两种方法首次操作的穿刺成功率、留置并发症（如出血、红肿、感染、输液不畅）及操作时间。

结果

对照组和实验组患者的年龄、体重指数、性别、体温、平均动脉压、序贯器官衰竭评分、血管加压素需要量、中心静脉压、白细胞、血红蛋白、血小板、白蛋白和机械通气比较，差异均无统计学意义（均 P>0.05）。实验组 ICU 或 NCU 住院时间为 5 天，对照组为 7 天（P=0.009）。与对照组相比，实验组穿刺成功时间更短（4.0 分钟比 6.0 分钟，P<0.001），首次穿刺成功率更高（93%比 71%，Ρ=0.023），并发症发生率更低（12.5%比 45.0%，P=0.001）。