改良平肩水平式锁骨下静脉穿刺术的分析(1)
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[摘要] 目的 探讨锁骨下静脉穿刺采用平肩水平式贴锁骨下进针的方法与效果及并发症。方法 择期手术病例500例，随机分为实验组和对照组各250例。实验组锁骨下静脉穿刺方法是改良平肩水平式锁骨下静脉穿刺术；对照组锁骨下静脉穿刺是采用传统的一般锁骨下静脉穿刺术。结果 实验组采用改良平肩水平式贴锁骨下进针方法穿刺成功232例，成功率为92.8%；而对照组采用常规传统方法进行穿刺成功为199例，成功率79.6%。实验组与对照组锁骨下静脉穿刺方法比较具有显著性差异(P<0.05)。对照组并发症发生率较高，锁骨下静脉穿刺过程发生气胸18例，误伤锁骨下动脉25例，血气胸3例，纵膈血肿1例，皮下气肿2例；而实验组锁骨下静脉穿刺过程发生气胸仅3例，误伤锁骨下动脉为7例，并发症发生率实验组与对照组比较差异具有显著性(P<0.05)。结论 改良平肩水平式贴锁骨下进行锁骨下静脉穿刺方法可行，安全、成功率高，并发症发生率低，容易掌握和操作，可在临床上推广应用。
[关键词]平肩；锁骨下静脉；穿刺
[中图分类号] R61 [文献标识码] B [文章编号] 1673-9701(2011)26-28-03
The Analysis of Improving Horizontal and Flat Shoulder Subclavian Vein Puncture
WU Qunying
The Operating Room of Central Hospital of Jiangmen in Guangdong，Jiangmen 529031，China
[Abstract] Objective To investigate the use of subclavian vein puncture flat shoulder horizontal needle attached subclavian approach with the effects and complications. Methods All 500 cases of elective surgery patients were randomly divided into experimental and control group of 250 cases. Subclavian vein through the experimental group benefit is improved flat horizontal shoulder subclavian vein puncture. Control group subclavian vein puncture is commonly used in traditional general subclavian vein puncture. Results The modified flat horizontal shoulder paste method of subclavian puncture needle 232 cases of success， the success rate of 92.8%. While the control group using conventional methods of successful puncture traditional 199 cases， the success rate of 79.6%. Experimental group and control group subclavian vein puncture method is a significant difference(P<0.05). Conclusion rate control group the highest incidence of subclavian vein puncture and pneumothorax occurred during 18 cases of accidental injury of the subclavian artery in 25 cases， pneumothorax in 3 cases， mediastinal hematoma， subcutaneous emphysema in 2 cases. The experimental group subclavian vein puncture occurred during only 3 cases of pneumothorax， accidental injury of the subclavian artery in 7 cases. Complication rate experimental group and control group difference was significant(P<0.05). Conclusion The modified flat horizontal shoulder paste subclavian puncture the subclavian vein puncture method is feasible， safe， high success rate ......
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