超声引导下不同部位中心静脉置管在婴幼儿休克中的应用及临床分析

Application of ultrasound-guided central venous catheterization at various sites in infants with shock

摘要:

目的 分析超声引导下不同部位中心静脉置管在婴幼儿休克中应用的临床特点，探讨在婴幼儿休克中应如何快速选择中心静脉置管部位。 方法 回顾性收集2016年1月至2020年12月广东医科大学附属东莞儿童医院儿童重症监护室收治的112例诊断为休克并进行中心静脉置管的婴幼儿临床资料，根据是否在超声引导下进行置管分为超声组（70例）及体表定位组（42例），总结分析患儿在超声引导下不同部位置管的应用情况，对各部位置管的一针成功率、总成功率、置管时间及并发症进行比较。 结果 与体表定位组相比，超声组颈内静脉及股静脉置管的一针成功率增高，置管时间缩短，并发症发生率减少（P<0.05）。超声组中，行颈内静脉置管比例最高（51%，36/70），其次为股静脉（33%，23/70），锁骨下静脉最少（16%，11/70）。超声引导下不同置管部位比较，颈内静脉成功置管时间最短［5.5（5.0，6.5）min］（P<0.05）；不同置管部位的并发症发生率比较差异无统计学意义（P>0.05）。 结论 在婴幼儿休克状态下，应用超声引导下行颈内静脉置管可作为临床医生优先选择的置管方式。 引用格式：中国当代儿科杂志，2022，24（5）：591-595

Abstract:

Objective To study the clinical characteristics of ultrasound-guided central venous catheterization at various sites in infants with shock, and to explore how to quickly select the site for central venous puncture in infants with shock. Methods The medical data of 112 infants who were diagnosed with shock and underwent central venous catheterization in the Pediatric Intensive Care Unit, Dongguan Children's Hospital Affiliated to Guangdong Medical University, from January 2016 to December 2020 were reviewed retrospectively. The patients were divided into an ultrasound group (n=70) and a body surface location group (n=42) according to whether the catheterization was carried out under ultrasound guidance. The application of ultrasound-guided catheterization at various sites in infants was summarized and analyzed, and the success rate of one-time puncture, overall success rate, catheterization time, and complications were compared between these sites. Results Compared with the body surface location group, the ultrasound group had a significantly higher success rate of one-time puncture, a significantly shorter catheterization time, and a significantly reduced incidence rate of complications in internal jugular vein and femoral vein catheterizations (P<0.05). In the ultrasound group, the proportion of internal jugular vein catheterization was the highest (51%, 36/70), followed by femoral vein catheterization (33%, 23/70), and subclavian vein catheterization (16%, 11/70). For the comparison between different puncture sites under ultrasound guidance, internal jugular vein catheterization showed the shortest time of a successful catheterization [5.5 (5.0, 6.5) minutes] (P<0.05). There was no significant difference in the incidence rate of complications among the different puncture sites groups (P>0.05). Conclusions In infants with shock, ultrasound-guided internal jugular vein catheterization can be used as the preferred catheterization method for clinicians. Citation:Chinese Journal of Contemporary Pediatrics, 2022, 24(5): 591-595