CAJ | 학술논문

目的探讨应用超声引导定位在经锁骨下静脉人路置入植入式输液港的效果.方法选择乳腺癌患者60例,年龄28～63岁,体重41～70 kg,身高150～168 cm,ASA Ⅰ或Ⅱ级,拟经锁骨下静脉穿刺置入植入式输液港行长期输液及化疗,输液港导管尖端位置应在上腔静脉和右心房交界处.随机分为2组(n=30):对照组(C组)经锁骨下静脉穿刺,采用脉冲注射冰盐水实验的方法引导定位植入式输液港导管尖端位置.超声组(U组)经锁骨下静脉穿刺,采用超声引导定位植入式输液港导管尖端位置.所有患者术后均经过X线摄片进行导管定位.计算两组患者首次置入成功率.结果 U组患者术后X线摄片显示输液港导管尖端均在上腔静脉和右心房交界处,未发生导管偏离进入颈内静脉的现象,首次置入成功率100%.C组术后X线摄片显示有6例患者的输液港导管发生了偏离,进入颈内静脉,需回手术室在超声引导定位下重新穿刺置管,首次置入成功率80%.U组首次置入成功率高于C组(P<0.05).结论超声引导定位是经锁骨下静脉正确放置植入式输液港的有效手段.
목적 탐토응용초성인도정위재경쇄골하정맥인로치입식입식수액항적효과.방법 선택유선암환자60례,년령28～63세,체중41～70 kg,신고150～168 cm,ASA Ⅰ혹Ⅱ급,의경쇄골하정맥천자치입식입식수액항행장기수액급화료,수액항도관첨단위치응재상강정맥화우심방교계처.수궤분위2조(n=30):대조조(C조)경쇄골하정맥천자,채용맥충주사빙염수실험적방법인도정위식입식수액항도관첨단위치.초성조(U조)경쇄골하정맥천자,채용초성인도정위식입식수액항도관첨단위치.소유환자술후균경과X선섭편진행도관정위.계산량조환자수차치입성공솔.결과 U조환자술후X선섭편현시수액항도관첨단균재상강정맥화우심방교계처,미발생도관편리진입경내정맥적현상,수차치입성공솔100%.C조술후X선섭편현시유6례환자적수액항도관발생료편리,진입경내정맥,수회수술실재초성인도정위하중신천자치관,수차치입성공솔80%.U조수차치입성공솔고우C조(P<0.05).결론 초성인도정위시경쇄골하정맥정학방치식입식수액항적유효수단.
Objeetlve To avoid inserting the tip of the central venous catheter into internal jugular vein (IJV) through subclavian vein under ultrasound guidance.Methods sixty breast cancel patients aged 28-63 yr weighing 41-70 kg who needed long-term intravenous infusion and chemotherapy through central venous catheter were randomly divided into 2 groups (n=30 each):control group (group C) and ultrasound group (group U).In group C the insertion of central venous catheter through subclavian vein was guided by pulsatile injection of ice-cold saline.In group U ultrasound detector (type HFL 38/13-6 MH,Sonosite Co,USA) was used to guide the insertion of tbe central vesons catheter.The position of the catheter tip was verified by X-ray radiography.The rate of successful placement at 1st attempt was calculated.Results The tip of the central venous catheter was correctly placed in the vena cava and right atrium in all patients in group U (success rate 100%),while in group C the tip was misplaced in IJV in 6 patients (success rate 80%) and had to be replaced.Conclusion Ultrasound guidance is effective for correct placement of the tip of central venous catheter in the vema cava and right atrium through subclavian vein.