中国医科大学学报

中国医科大学学报
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中国医科大学学报 ›› 2019, Vol. 48 ›› Issue (5): 421-424.doi: 10.12007/j.issn.0258-4646.2019.05.010

• 论著 • 上一篇    下一篇

改良超声引导中心静脉置管术在婴儿体外循环先天性心脏病矫正术中的应用

孙世伟, 吴秀英   

  1. 中国医科大学附属盛京医院麻醉科, 沈阳 110004
  • 收稿日期:2018-04-11 出版日期:2019-05-30 发布日期:2019-05-15
  • 通讯作者: 吴秀英 E-mail:wuxy@sj-hospital.org
  • 作者简介:孙世伟(1982-),男,讲师,博士.

Application of a Modified Ultrasound-Guided Central Venous Cannulation Technique for the Correction of Congenital Heart Diseases in Infants through Cardiopulmonary Bypass

SUN Shiwei, WU Xiuying   

  1. Department of Anesthesiology, Shengjing Hospital, China Medical University, Shenyang 110004, China
  • Received:2018-04-11 Online:2019-05-30 Published:2019-05-15

摘要: 目的评价结合22G静脉套管针的改良超声引导中心静脉置管术在婴儿体外循环先天性心脏病矫正术中应用的可行性。方法将2017年1月至12月期间在我院行择期先天性心脏病矫正术的72例婴儿随机分为传统组(C组,n=36)和改良组(M组,n=36),分别行传统超声引导中心静脉置管或结合22G静脉套管针的改良超声引导中心静脉置管术。比较2组患儿的年龄、体质量、穿刺时间、穿刺次数、一次成功率及并发症的发生情况。结果 2组患儿年龄、体质量无统计学差异,具有可比性。C组穿刺时间[(7.92±3.55)min]长于M组[(5.69±1.35)min],穿刺次数[(1.42±0.69)次]多于M组[(1.11±0.32)次],一次成功率[70%(25/36)]低于M组[88%(32/36)],差异均有统计学意义(均P<0.05)。C组出现颈部血肿7例,M组未出现,有统计学差异(χ2=5.697,P<0.05)。2组均未出现血气胸、心律失常或气栓。结论在婴儿体外循环先天性心脏病矫正术中,与传统超声引导中心静脉置管相比,结合22G静脉套管针的改良超声引导中心静脉置管术能够降低操作难度,缩短置管时间,提高一次成功率,减少并发症,更为安全有效,值得临床推广。

关键词: 婴儿, 先天性心脏病, 超声引导中心静脉置管, 22G静脉套管针

Abstract: Objective To evaluate the usefulness of a modified ultrasound-guided central venous cannulation technique using a 22G intravenous trocar. Methods A total of 72 infants undergoing congenital heart disease correction in our hospital from January to December 2017 were randomly divided into the conventional ultrasound-guided puncture group(group C,n=36)and modified ultrasound-guided puncture group(group M,n=36). Results No significant difference in age and body weight was found between the two groups. The puncture time was 7.92±3.55 min in group C and 5.69±1.35 min in group M(P<0.05). The puncture frequency was 1.42±0.69 and 1.11±0.32 in groups C and M,respectively(P<0.05). The one-time success rate was 70%(25/36)and 88%(32/36)in groups C and M, respectively(χ2=4.126,P<0.05). No hemopneumothorax,arrhythmia,or gas embolism was observed in either group. Seven patients in group C and no patient in group M developed right internal jugular hematoma(χ2=5.697,P<0.05). Conclusion Compared with the conventional ultrasound-guided technique,the modified technique using a 22G intravenous trocar for the correction of congenital heart disease in infants through cardiopulmonary bypass can minimize the difficulty,shorten the puncture time,increase the one-time success rate,and reduce the complication rate.

Key words: infant, congenital heart disease, ultrasound-guided central venous cannulation, 22G intravenous trocar

中图分类号: 

  • R614.2
[1] KOCUM A,SENER M,CALISKAN E,et al. An alternative central venous route for cardiac surgery:supraclavicular subclavian vein catheterization[J]. J Cardiothorac Vasc Anesth,2011,25(6):1018-1023. DOI:10.1053/J.JVCA.2011.02.006.
[2] HOFFMAN T,DU PLESSIS M,PREKUPEC MP,et al. Ultrasound-guided central venous catheterization:a review of the relevant anatomy,technique,complications,and anatomical variations[J]. Clin Anat,2017,30(2):237-250. DOI:10.1002/CA.22768.
[3] NAKAYAMA S,YAMASHITA M,OSAKA Y,et al. Right internal jugular vein venography in infants and children[J]. Anesth Analg, 2001,93(2):331-334,332nd contents page.
[4] RAY BR,MOHAN VK,KASHYAP L,et al. Internal jugular vein cannulation:a comparison of three techniques[J]. J Anaesthesiol Clin Pharmacol,2013,29(3):367-371. DOI:10.4103/0970-9185.117115.
[5] PALEPU GB,DEVEN J,SUBRAHMANYAM M,et al. Impact of ultrasonography on central venous catheter insertion in intensive care[J]. Indian J Radiol Imaging 2009,19(3):191-198. DOI:10.4103/0971-3026.54877.
[6] FATHI M,IZANLOO A,JAHANBAKHSH S,et al. Central venous cannulation of the internal jugular vein using ultrasound-guided and anatomical landmark techniques[J]. Anesthesiol Pain Med,2016,6(3):e35803. DOI:10.5812/aapm.35803.
[7] CHU PY,LI JS,KOSINSKI AS,et al. Congenital heart disease in premature infants 25-32 weeks' gestational age[J]. J Pediatr,2017,181:37-41.e31. DOI:10.1016/J.JPEDS.2016.10.033.
[8] MONTES-TAPIA F,RODRIGUEZ-TAMEZ A,HERNANDEZ-GARDUNO A,et al. Vascular assessment of the right internal jugular vein in low birth weight newborns[J]. J Matern Fetal Neonatal Med,2013, 26(15):1510-1513. DOI:10.3109/14767058.2013.789853.
[9] NAUMBURG E,SODERSTROM L,HUBER D,et al. Risk factors for pulmonary arterial hypertension in children and young adults[J]. Pediatr Pulmonol,2017,52(5):636-641. DOI:10.1002/ppul.23633.
[10] RICCI Z,IACOELLA C,COGO P. Fluid management in critically ill pediatric patients with congenital heart disease[J]. Minerva Pediatr, 2011,63(5):399-410.
[11] PAOLETTI F,RIPANI U,ANTONELLI M,et al. Central venous catheters. Observations on the implantation technique and its complications[J]. Minerva Anestesiol,2005,71(9):555-560.
[12] LEGLER D,NUGENT M. Doppler localization of the internal jugular vein facilitates central venous cannulation[J]. Anesthesiology, 1984,60(5):481-482.
[13] KARAKITSOS D,LABROPOULOS N,DE GROOT E,et al. Real-time ultrasound-guided catheterisation of the internal jugular vein:a prospective comparison with the landmark technique in critical care patients[J]. Crit Care,2006,10(6):R162.
[14] HOSOKAWA K,SHIME N,KATO Y,et al. A randomized trial of ultrasound image-based skin surface marking versus real-time ultrasound-guided internal jugular vein catheterization in infants[J]. Anesthesiology,2007,107(5):720-724.
[15] VERGHESE ST,MCGILL WA,PATEL RI,et al. Ultrasound-guided internal jugular venous cannulation in infants:a prospective comparison with the traditional palpation method[J]. Anesthesiology, 1999,91(1):71-77.
[16] CHUAN WX,WEI W,YU L. A randomized-controlled study of ultrasound prelocation vs anatomical landmark-guided cannulation of the internal jugular vein in infants and children[J]. Paediatr Anaesth,2005,15(9):733-738.
[17] RUESCH S,WALDER B,TRAMER MR. Complications of central venous catheters:internal jugular versus subclavian access——a systematic review[J]. Crit Care Med,2002,30(2):454-460.
[18] ASHEIM P,MOSTAD U,AADAHL P. Ultrasound-guided central venous cannulation in infants and children[J]. Acta Anaesthesiol Scand,2002,46(4):390-392.
[19] WU SY,LING Q,CAO LH,et al. Real-time two-dimensional ultrasound guidance for central venous cannulation:a meta-analysis[J]. Anesthesiology,2013,118(2):361-375. DOI:10.1097/ALN.0b013e31827bd172.
[20] BRESCHAN C,PLATZER M,LIKAR R. Central venous catheter for newborns,infants and children[J]. Anaesthesist,2009,58(9):897-900,902-904. DOI:10.1007/s00101-009-1602-4.
[21] MONTES-TAPIA F,RODRIGUEZ-TAMEZ A,CURA-ESQUIVEL I, et al. Efficacy and safety of ultrasound-guided internal jugular vein catheterization in low birth weight newborn[J]. J Pediatr Surg,2016, 51(10):1700-1703. DOI:10.1016/J.JPEDSURG.2016.05.014.
[22] MARTIN MJ,HUSAIN FA,PIESMAN M,et al. Is routine ultrasound guidance for central line placement beneficial? a prospective analysis[J]. Curr Surg,2004,61(1):71-74.
[23] BRESCHAN C,PLATZER M,JOST R,et al. Size of internal jugular vs subclavian vein in small infants:an observational,anatomical evaluation with ultrasound[J]. Br J Anaesth,2010,105(2):179-184. DOI:10.1093/BJA/AEQ123.
[24] PLUMHANS C,MAHNKEN AH,OCKLENBURG C,et al. Jugular versus subclavian totally implantable access ports:catheter position, complications and intrainterventional pain perception[J]. Eur J Radiol,2011,79(3):338-342. DOI:10.1016/J.EJRAD.2009.12.010.
[25] ALDERSON PJ,BURROWS FA,STEMP LI,et al. Use of ultrasound to evaluate internal jugular vein anatomy and to facilitate central venous cannulation in paediatric patients[J]. Br J Anaesth,1993,70(2):145-148.
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