CAJ | 학술논문

目的：探讨彩色多普勒超声引导锁骨下静脉穿刺术对临床需多次重复置管患者的应用价值及安全性。方法对3380例在超声科实施彩超引导锁骨下静脉穿刺置管患者的临床资料进行回顾性分析，按置管需求次数归类为A组（首次置管）、B组（重复置管2~3次）及C组（重复置管4次及以上）。观察各组总成功率及穿刺一次成功率、并发症种类及发生率等，并进行统计比较。结果3380例患者中，首次置管A组1644例，穿刺一次成功、穿刺两次及以上成功分别为1556例（94.6％）和87例（5.3％），失败1例，总成功率99.9％；重复置管B组1224例，穿刺一次成功、穿刺两次及以上成功分别为1148例（93.8％）和75例（6.1％），失败1例，总成功率为99.9％；多次置管C组512例，穿刺一次成功、穿刺两次及以上成功分别为438例（85.5％）和69例（13.5％），失败5例，总成功率99.0％；与A、B两组相比，C组的穿刺总成功率、一次成功率较低，差异具有统计学意义（ P <0.01）。三组共发生穿刺并发症29例，总发生率0.9％，其中C组并发症发生率（12/512，2.3％）明显高于A组（9/1644，0.5％）和B组（8/1224，0.7％），差异有非常显著性（ P <0.01）。另外，穿刺过程中导丝误入颈内静脉共541例，占16.0％，三组分别为279（16.8％）、185（14.9％）、77（15.0％）例，组间比较其发生率无显著差异（ P >0.05）。结论彩色多普勒超声引导锁骨下静脉穿刺置管术简便、安全，置管成功率高，尤其对于临床需多次重复置管的患者（如恶性肿瘤化疗、肥胖、胸廓畸形、水肿等），同样效果可靠。术前、术中仔细探查可减少置管失败和穿刺并发症的发生，对提高临床救治质量，降低医疗风险具有较高应用价值。
목적：탐토채색다보륵초성인도쇄골하정맥천자술대림상수다차중복치관환자적응용개치급안전성。방법대3380례재초성과실시채초인도쇄골하정맥천자치관환자적림상자료진행회고성분석，안치관수구차수귀류위A조（수차치관）、B조（중복치관2~3차）급C조（중복치관4차급이상）。관찰각조총성공솔급천자일차성공솔、병발증충류급발생솔등，병진행통계비교。결과3380례환자중，수차치관A조1644례，천자일차성공、천자량차급이상성공분별위1556례（94.6％）화87례（5.3％），실패1례，총성공솔99.9％；중복치관B조1224례，천자일차성공、천자량차급이상성공분별위1148례（93.8％）화75례（6.1％），실패1례，총성공솔위99.9％；다차치관C조512례，천자일차성공、천자량차급이상성공분별위438례（85.5％）화69례（13.5％），실패5례，총성공솔99.0％；여A、B량조상비，C조적천자총성공솔、일차성공솔교저，차이구유통계학의의（ P <0.01）。삼조공발생천자병발증29례，총발생솔0.9％，기중C조병발증발생솔（12/512，2.3％）명현고우A조（9/1644，0.5％）화B조（8/1224，0.7％），차이유비상현저성（ P <0.01）。령외，천자과정중도사오입경내정맥공541례，점16.0％，삼조분별위279（16.8％）、185（14.9％）、77（15.0％）례，조간비교기발생솔무현저차이（ P >0.05）。결론채색다보륵초성인도쇄골하정맥천자치관술간편、안전，치관성공솔고，우기대우림상수다차중복치관적환자（여악성종류화료、비반、흉곽기형、수종등），동양효과가고。술전、술중자세탐사가감소치관실패화천자병발증적발생，대제고림상구치질량，강저의료풍험구유교고응용개치。
Objective To explore the significance of clinical application and safety of repeated-subclavian vein puncture under the guid-ance of color Doppler ultrasound. Methods The data of 3 380 cases with subclavian vein puncture guided by ultrasound catheter in this hospital were retrospectively analyzed,and they were classified into group A with the first time puncture,group B with repeated(2~3 times)punctures and group C with multiple punctures( more than 3 times)according to the times of insertion. Then,the total successful rate and successful rate of first puncture,incidence of complications and types etc were observed and analyzed in each group by statistical method. Results Among 1 644 cases of group A,there were 1 556 cases(94. 6%)with the first-time successful insertion,and 87 cases(5. 3%)with twice or more-times successful insertion,respectively. Only 1 case failed in puncture. The total successful rate was 99. 9%. In group B of total 1 224 cases,there were 1148 cases(93. 8%)and 75 cases(6. 1%)with first-time and twice or more-times successful insertions,respectively,and there was 1 case failed. The total successful rate was same as 99. 9%. For 512 cases in group C,438 cases(85. 5%)got the first-time successful insertion, and 69 cases(13. 5%)got successful insertion by twice or more-times. However,there were 5 cases failed,and the successful rate was 99. 0%. The total successful rate in group C was obviously lower than that of group A or B. Similarly,the successful rate of first-time insertion in group C had significant difference compared with that of group A or B( P <0. 01). The complications of puncture occurred in 29 cases. The total incidence was 0. 9%,among them the complication rate in group C(12/512,2. 3%)was significantly higher than that of group A(9/1 644,0. 5%)and group B(8/1 224,0. 7%)( P <0. 01). In addition,the guide wire inserted into internal jugular vein in 541 cases,accounting for 16% of all cases,and it had been occurred in 279(16. 8%),185(14. 9%),and 77(15. 0%)in each group,respectively. The difference had no statistical significance among these groups( P >0. 05). Conclusion With higher successful rate,subclavian vein puncture under the guid-ance of color Doppler ultrasonography is convenient,effective and safe,especially for patients with clinical need for repeated catheterization such as chemotherapy in cases of malignant tumor,obesity and thoracic deformity,edema,etc. Preoperative and intraoperative careful exploration can reduce the failure rate and complications of punctures,thus it can raise the quality of clinical treatment and reduce the medical risks. Hence it will have higher value for clinical application.