肾脏替代治疗中超声引导股静脉置管在低穿刺经验医生中的应用(1)
【摘要】 目的：评价在肾脏替代治疗中超声引导股静脉置管在低穿刺经验医师中的应用效果。方法：监护病房内需肾脏替代治疗的120例患者在局麻下穿刺股静脉置入深静脉导管，按照随机数字表法分为超声引导低穿刺经验医师组(A组)和体表解剖定位高穿刺经验医师组(B组)，每组60例，每组分别由两位医师操作。记录并比较两组操作时间、首次穿刺进针置管成功率、二次置管成功率、总成功率、机械并发症发生情况(如误传动脉、动静脉瘘、局部血肿、腹膜后出血)。结果：A组操作时间及并发症显著少于B组，首次进针置管成功率、总成功率高于B组，组间比较差异均有统计学意义(P<0.05)。结论：在肾脏替代治疗中，应用超声引导穿刺股静脉置管能缩短操作时间、减少机械并发症，还能缩短重症医师的深静脉操作培训时间。
【关键词】 肾脏替代治疗； 超声引导； 股静脉置管； 操作培训
中图分类号 R459.5 文献标识码 B 文章编号 1674-6805(2015)16-0028-02
【Abstract】 Objective：To evaluate the application status of femoral vein catheterization in physicians with poor experience in ultrasound-guided puncture during renal replacement therapy.Method：120 patients who need renal replacement therapy in ICU were enrolled to indwell deep venous catheter via femoral vein puncture under local anesthesia.These patients were randomly assigned into group A(manipulated by physicians with poor experience in ultrasound-guided puncture)，and group B(performed by physicians with extensive experience in body surface anatomical positioning puncture)，60 cases in each group，who had their puncture done by two physicians separately in one of such groups.Duration of procedures，success rate at the first catheterization，the success rate at the second catheterization，total success rate and the rate of each complication of two groups were recorded and compared.Result：Duration of procedures and complication incidence of group A were significantly shorter and lower than those of group B，the success rate of first catheterization and total success rate of group A were higher than that of group B，there were statistical significances in differences above-mentioned when compared between groups(P<0.05).Conclusion：In renal replacement therapy，application of ultrasound guided femoral vein catheter can shorten operation time and reduce mechanical complications，as well as shrink the training session of deep vein operation needed for intensivist.
【Key words】 Renal replacement therapy； Ultrasound-guided； Vein catheterization； Train
First-author’s address：Beijing Shunyi District Hospital，Beijing 101300，China
doi：10.14033/j.cnki.cfmr.2015.16.014
监护病房需要广泛应用中心静脉置管术，如肾脏替代治疗、血流动力学监测、深静脉用药以及胃肠外营养。在深静脉置管过程中，容易出现导管相关性机械并发症，如误传动脉、出血、血肿、气胸、腹膜后出血、动静脉瘘、导管尖端易位等。传统操作方法是采用解剖定位法盲穿，近年逐渐引用超声引导穿刺，超声扫描能提供活体状态下颈内静脉体表投影及局部解剖关系[1]。超声引导的颈内静脉置管能提高第一次穿刺成功率、减少误传动脉几率、减少操作时间，同时节约医疗花费[2-3]。监护病房内约4%的重症患者需要肾脏替代治疗[4]，而建立血管通路是肾脏替代治疗的前提。肾脏替代治疗需要置入较大口径深静脉导管，出现并发症后造成更大损伤。颈内静脉、股静脉是肾脏替代治疗的常用通路[5]。本文将就肾脏替代治疗前，超声引导与体表解剖定位行股静脉置管在不同经验医师间的应用进行比较研究，现报告如下。, 百拇医药(张晓东 董磊 张海燕)
【关键词】 肾脏替代治疗； 超声引导； 股静脉置管； 操作培训
中图分类号 R459.5 文献标识码 B 文章编号 1674-6805(2015)16-0028-02
【Abstract】 Objective：To evaluate the application status of femoral vein catheterization in physicians with poor experience in ultrasound-guided puncture during renal replacement therapy.Method：120 patients who need renal replacement therapy in ICU were enrolled to indwell deep venous catheter via femoral vein puncture under local anesthesia.These patients were randomly assigned into group A(manipulated by physicians with poor experience in ultrasound-guided puncture)，and group B(performed by physicians with extensive experience in body surface anatomical positioning puncture)，60 cases in each group，who had their puncture done by two physicians separately in one of such groups.Duration of procedures，success rate at the first catheterization，the success rate at the second catheterization，total success rate and the rate of each complication of two groups were recorded and compared.Result：Duration of procedures and complication incidence of group A were significantly shorter and lower than those of group B，the success rate of first catheterization and total success rate of group A were higher than that of group B，there were statistical significances in differences above-mentioned when compared between groups(P<0.05).Conclusion：In renal replacement therapy，application of ultrasound guided femoral vein catheter can shorten operation time and reduce mechanical complications，as well as shrink the training session of deep vein operation needed for intensivist.
【Key words】 Renal replacement therapy； Ultrasound-guided； Vein catheterization； Train
First-author’s address：Beijing Shunyi District Hospital，Beijing 101300，China
doi：10.14033/j.cnki.cfmr.2015.16.014
监护病房需要广泛应用中心静脉置管术，如肾脏替代治疗、血流动力学监测、深静脉用药以及胃肠外营养。在深静脉置管过程中，容易出现导管相关性机械并发症，如误传动脉、出血、血肿、气胸、腹膜后出血、动静脉瘘、导管尖端易位等。传统操作方法是采用解剖定位法盲穿，近年逐渐引用超声引导穿刺，超声扫描能提供活体状态下颈内静脉体表投影及局部解剖关系[1]。超声引导的颈内静脉置管能提高第一次穿刺成功率、减少误传动脉几率、减少操作时间，同时节约医疗花费[2-3]。监护病房内约4%的重症患者需要肾脏替代治疗[4]，而建立血管通路是肾脏替代治疗的前提。肾脏替代治疗需要置入较大口径深静脉导管，出现并发症后造成更大损伤。颈内静脉、股静脉是肾脏替代治疗的常用通路[5]。本文将就肾脏替代治疗前，超声引导与体表解剖定位行股静脉置管在不同经验医师间的应用进行比较研究，现报告如下。, 百拇医药(张晓东 董磊 张海燕)
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