[超声引导下不同部位中心静脉置管在休克婴幼儿中的应用]
[Application of ultrasound-guided central venous catheterization at various sites in infants with shock].
作者信息
Tan Zi-Feng, Ma Ke-Ze, Lai Zhi-Jun
机构信息
Pediatric Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, Dongguan, Guangdong 523325, China.
出版信息
Zhongguo Dang Dai Er Ke Za Zhi. 2022 May 15;24(5):591-595. doi: 10.7499/j.issn.1008-8830.2111097.
OBJECTIVES
To study the clinical characteristics of ultrasound-guided central venous catheterization at various sites in infants with shock, and to explore how to quickly select the site for central venous puncture in infants with shock.
METHODS
The medical data of 112 infants who were diagnosed with shock and underwent central venous catheterization in the Pediatric Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, from January 2016 to December 2020 were reviewed retrospectively. The patients were divided into an ultrasound group (=70) and a body surface location group (=42) according to whether the catheterization was carried out under ultrasound guidance. The application of ultrasound-guided catheterization at various sites in infants was summarized and analyzed, and the success rate of one-time puncture, overall success rate, catheterization time, and complications were compared between these sites.
RESULTS
Compared with the body surface location group, the ultrasound group had a significantly higher success rate of one-time puncture, a significantly shorter catheterization time, and a significantly reduced incidence rate of complications in internal jugular vein and femoral vein catheterizations (<0.05). In the ultrasound group, the proportion of internal jugular vein catheterization was the highest (51%, 36/70), followed by femoral vein catheterization (33%, 23/70), and subclavian vein catheterization (16%, 11/70). For the comparison between different puncture sites under ultrasound guidance, internal jugular vein catheterization showed the shortest time of a successful catheterization [5.5 (5.0, 6.5) minutes] (<0.05). There was no significant difference in the incidence rate of complications among the different puncture sites groups (>0.05).
CONCLUSIONS
In infants with shock, ultrasound-guided internal jugular vein catheterization can be used as the preferred catheterization method for clinicians.
目的
研究超声引导下不同部位中心静脉置管在休克患儿中的临床特点，探讨如何快速为休克患儿选择中心静脉穿刺部位。
方法
回顾性分析2016年1月至2020年12月在广东医科大学附属东莞儿童医院儿科重症监护病房诊断为休克并接受中心静脉置管的112例患儿的病历资料。根据置管是否在超声引导下进行，将患者分为超声组（n = 70）和体表定位组（n = 42）。总结分析超声引导下婴儿不同部位置管的应用情况，并比较这些部位的一次穿刺成功率、总成功率、置管时间及并发症。
结果
与体表定位组相比，超声组在颈内静脉和股静脉置管时的一次穿刺成功率显著更高，置管时间显著更短，并发症发生率显著降低（P < 0.05）。在超声组中，颈内静脉置管比例最高（51%，36/70），其次是股静脉置管（33%，23/70），锁骨下静脉置管（16%，11/70）。对于超声引导下不同穿刺部位的比较，颈内静脉置管成功时间最短[5.5（5.0，6.5）分钟]（P < 0.05）。不同穿刺部位组间并发症发生率差异无统计学意义（P > 0.05）。
结论
对于休克患儿，超声引导下颈内静脉置管可作为临床医生的首选置管方法。
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