CAJ | 학술논문

目的：评价右心房心电图( right- artrial ECG,RAECG)引导与常规技术( convenitional placement techniques, CT)行右锁骨下静脉穿刺导管尖端位置的到位率及其他不良反应。方法40例择期行全身麻醉的骨科手术患者,经数字随机表均分为2组,分别接受右心房心电图引导右锁骨下中心静脉置管技术(A组,n=20)、传统常规右锁骨下静脉置管技术(B组,n=20),穿刺结束即刻通过C臂或床旁X-胸片观察导管的走向,记录各组患者导管尖端位置,导管平均置入深度以及导管异位情况。结果 A组患者导管尖端位于上腔静脉18例,2例异位于右颈内静脉,导管位置精确率90%,B组患者导管尖端位于上腔静脉14例,6例异位于右颈内静脉,导管位置精确率70%,两组间比较差异有统计学意义( P<0．05)；A组患者导管置入平均深度(11．3±1．2)cm,B组患者导管置入平均深度(14．45±1．6)cm,两组间比较差异有统计学意义(P<0．05)；两组间穿刺时间、误穿动脉、气胸等不良反应发生率比较差异无统计学意义(P>0．05)。结论右心房心电图引导行右锁骨下静脉穿刺导管尖端位置的到位率优于传统置管法,且导管置入深度少于传统法,值得临床推广应用。
목적：평개우심방심전도( right- artrial ECG,RAECG)인도여상규기술( convenitional placement techniques, CT)행우쇄골하정맥천자도관첨단위치적도위솔급기타불량반응。방법40례택기행전신마취적골과수술환자,경수자수궤표균분위2조,분별접수우심방심전도인도우쇄골하중심정맥치관기술(A조,n=20)、전통상규우쇄골하정맥치관기술(B조,n=20),천자결속즉각통과C비혹상방X-흉편관찰도관적주향,기록각조환자도관첨단위치,도관평균치입심도이급도관이위정황。결과 A조환자도관첨단위우상강정맥18례,2례이위우우경내정맥,도관위치정학솔90%,B조환자도관첨단위우상강정맥14례,6례이위우우경내정맥,도관위치정학솔70%,량조간비교차이유통계학의의( P<0．05)；A조환자도관치입평균심도(11．3±1．2)cm,B조환자도관치입평균심도(14．45±1．6)cm,량조간비교차이유통계학의의(P<0．05)；량조간천자시간、오천동맥、기흉등불량반응발생솔비교차이무통계학의의(P>0．05)。결론우심방심전도인도행우쇄골하정맥천자도관첨단위치적도위솔우우전통치관법,차도관치입심도소우전통법,치득림상추엄응용。
Objective To assess the targeting rate and adverse events of right-artrial ECG ( RAECG) guided versus conven-tional subclavicular vein tube palcement techniques ( CT) . Methods 40 orthopedics participants under general anesthesia were ran-domly divided into two groups by a random number table. Group A ( n=20 ) got RAECT guided subclavicular vein catheter and Group B (n=20) got CT. The direction of the tube, loaction of the tip of the tube, average catheter depth and ectopia of the tube were recorded by C-arm or chest pain film immediately after the acupuncture. Results Group A had 18 participants with the tip of the tube in superior vena cava and 2 in right internal jugular vein, the accuracy of tube location was 90%;in Group B, 14 partici-pants had the tip of the tube in superior vena cava, 6 in right internal jugular vein, the accuracy was 70%, there was significant dif-ferece between the two groups (P<0. 05). The depth of catheter in Group A was (11. 3 ± 1. 2)cm, and (14. 45 ± 1. 6)cm in Group B, with statistical significance between the two groups (P<0. 05); and there was no difference between the acupuncture time and adverse events (acupucture into arteries, rate of pneumothorax) in two groups (P >0. 05). Conclusion The targeting rate of RAECG was better than CT, and the depth of the tube was smaller in RAECG group. So RAECG is a good techique and should be spread in clincal works.