CAJ | 학술논문

目的探讨锁骨下静脉置管误入同侧颈内静脉的危险因素. 方法收集2011年1月至2012年12月间上海交通大学医学院附属仁济医院外科监护室行锁骨下静脉置管成功的患者178例,均采用Seldinger技术进行置管.记录患者性别、年龄、穿刺部位、穿刺位点、进针方向、穿刺针针尖斜面方向、导引钢丝J型头方向、穿刺时头部位置,先以单因素分析筛选出有统计学意义的危险因素,再应用多因素非条件logistic回归分析患者在锁骨下静脉置管进入颈内同侧颈内静脉的独立危险因素. 结果单因素分析表明:锁骨下静脉置管是否进入同侧颈内静脉与患者的性别(P=0.504)、年龄(P=0.200)、进针方向(P=0.370)、穿刺针针尖斜面方向(P=0.670)无关,与穿刺部位(P=0.012)、穿刺位点(P=0.012)、穿刺时导引钢丝J型头方向(P=0.000)、穿刺时患者头部位置(P=0.030)有关.多因素回归分析显示:锁骨下静脉置管时穿刺部位在右侧[危险度比值比(odds ratio,OR) =55.373,95％可信区间(confidence interval,CI):5.145～595.845,x2＝10.965,P=0.001]、导引钢丝J型头朝向颈内静脉(OR=24.116,95％ CI:6.848～84.918,x2=24.558,P=0.000)和穿刺时头部偏向穿刺对侧(OR=3.681,95％ CI:1.210～11.199,x2=5.268,P=0.022),为锁骨下静脉置管误入同侧颈内静脉的独立危险因素.共29例(16.29％)患者锁骨下静脉置管时进入同侧颈内静脉. 结论锁骨下静脉置管误入同侧颈内静脉是其常见的并发症,影响锁骨下静脉置管误入同侧颈内静脉的主要因素有穿刺部位选择右侧、导引钢丝J型头朝向颈内静脉、穿刺时头部偏向穿刺对侧.
목적 탐토쇄골하정맥치관오입동측경내정맥적위험인소. 방법 수집2011년1월지2012년12월간상해교통대학의학원부속인제의원외과감호실행쇄골하정맥치관성공적환자178례,균채용Seldinger기술진행치관.기록환자성별、년령、천자부위、천자위점、진침방향、천자침침첨사면방향、도인강사J형두방향、천자시두부위치,선이단인소분석사선출유통계학의의적위험인소,재응용다인소비조건logistic회귀분석환자재쇄골하정맥치관진입경내동측경내정맥적독립위험인소. 결과 단인소분석표명:쇄골하정맥치관시부진입동측경내정맥여환자적성별(P=0.504)、년령(P=0.200)、진침방향(P=0.370)、천자침침첨사면방향(P=0.670)무관,여천자부위(P=0.012)、천자위점(P=0.012)、천자시도인강사J형두방향(P=0.000)、천자시환자두부위치(P=0.030)유관.다인소회귀분석현시:쇄골하정맥치관시천자부위재우측[위험도비치비(odds ratio,OR) =55.373,95％가신구간(confidence interval,CI):5.145～595.845,x2＝10.965,P=0.001]、도인강사J형두조향경내정맥(OR=24.116,95％ CI:6.848～84.918,x2=24.558,P=0.000)화천자시두부편향천자대측(OR=3.681,95％ CI:1.210～11.199,x2=5.268,P=0.022),위쇄골하정맥치관오입동측경내정맥적독립위험인소.공29례(16.29％)환자쇄골하정맥치관시진입동측경내정맥. 결론 쇄골하정맥치관오입동측경내정맥시기상견적병발증,영향쇄골하정맥치관오입동측경내정맥적주요인소유천자부위선택우측、도인강사J형두조향경내정맥、천자시두부편향천자대측.
Objective To identify the risk factors of misplacement of subclavian venous catheterization into ipsilateral internal jugular vein.Methods From January 2011 to December 2012,subclavian venous catheterization was successfully performed with Seldinger method for 178 patients in department of surgical intensive care unit,Renji Hospital.The patients' sex,age,side and site of paracentesis,direction of puncture needle,direction of puncture needle bevel,direction of the J-Tip of the guidewire and position of the head during puncture were recorded.They were subjected to single factor analysis,and then independent risk factors for subclavian venous catheterization into ipsilateral internal jugular vein were determined with multivariate stepwise non-conditional logstic regression analysis.Results Single factor analysis showed that subclavian venous catheterization into ipsilateral internal jugular vein had no correlation with sex(P=0.504),age(P=0.504),direction of puncture needle (P=0.370),direction of puncture needle bevel (P=0.670),but had a correlation with paracentesis side (P=0.012),paracentesis site (P=0.012),direction of the J-Tip of the guidewire (P=0.000),and position of the patient head (P=0.030).Multivariate stepwise non-conditional logistic regression analysis showed that subclavian venous catheterization on the right side [odds ratio (OR) =55.373,95％ confidence interval (CI):5.145-595.845,x2=10.965,P=0.001],J-Tip of the guidewire directed toward internal jugular vein (OR=24.116,95％ CI:6.848-84.918,x2=24.558,P=0.000),and the head to the contralateral side of puncture(OR=3.681,95％ CI:1.210-11.199,x2=5.268,P=0.022) were independent factors.A total of 29 cases (16.29％) of patients experienced invasion of ipsilateral internal jugular vein during subclavian venous catheterization.Conclusions Subclavian venous catheterization misplacement into ipsilateral internal jugular vein is common.The risk factor of the catheter misplacement into ipsilateral internal jugular vein are subclavian venous catheterization on the right side,J-Tip of the guidewire-directed toward internal jugular vein,and the head to the contralateral side of puncture.