两种超声平面引导颈内静脉穿刺置管在肥胖患者 腹腔镜手术麻醉中的应用比较

Comparison of safety and availability of right internal jugular vein catheterization guided by two different ultrasound planes in obese patients undergoing laparoscopic surgery

摘要:

摘要：目的 比较斜轴平面法和短轴平面法超声引导右颈内静脉穿刺置管在肥胖患者腹腔镜手术麻醉中的安全性和有效性。方法 选择拟行超声引导右颈内静脉穿刺置管的择期腹腔镜手术肥胖患者120例，美国麻醉师协会分级（ASA）Ⅱ或Ⅲ级，年龄18～75岁，体质指数（BMI）>30 kg/m2，按随机数字表法分为斜轴平面法组（O组）和短轴平面法组（S组），每组60例。在超声引导下分别应用斜轴平面法和短轴平面法施行颈内静脉穿刺置管术，记录两组刺入目标血管的时间、总穿刺置管时间、穿刺点数目、改变进针方向次数、首次穿刺成功率、总成功率和穿刺置管并发症（误穿动脉、血胸和气胸等）。结果 两组总成功率均为100.0%，首次穿刺成功率比较差异无统计学意义（96.7% vs 93.3%，P>0.05）。与S组比较，O组刺入目标血管时间、总穿刺置管时间均明显缩短［（24.5±6.3）和（28.2±5.2）s，（234.8±24.0）和（265.2±21.0）s，P <0.05］。两组穿刺点数量比较差异无统计学意义（P >0.05）。O组患者改变进针方向次数明显少于S组（P <0.05）。误穿动脉O组0例，S组3例。两组均未发生血胸、气胸。结论 肥胖患者腹腔镜手术右颈内静脉穿刺置管采用超声引导安全可靠，首次穿刺成功率高。与短轴平面法比较，斜轴平面法可缩短穿刺置管时间，减少改变进针方向的次数，降低误穿颈总动脉的风险。

Abstract:

Abstract: Objective To compare the safety and availability of right internal jugular vein catheterization guided by oblique axis plane method and short axis plane method in obese patients undergoing laparoscopic surgery. Methods 120 obese patients underwent elective laparoscopic surgery anesthesia and requiring ultrasound-guided right internal jugular vein catheterization, ASA Ⅱ or Ⅲ, aged 18 ~ 75 years, BMI>30 kg/m2, were randomly divided into the oblique axis plane method group (group O) and the short axis plane method group (group S), with 60 cases in each group. The time of accessing into the target vein and catheterization, the number of skin puncture points and the changes of the needle direction, the first-time and final successful rate of puncture, and complications of the puncture and catheterization in both groups were recorded. Results The total successful rate of the two groups was 100.0%, there was no significant differences in the first-time successful rate of puncture between the two groups (96.7% vs 93.3%, P > 0.05). Compared with group S, the time of accessing into the target vein and catheterization in group O were significantly shortened [(24.5 ± 6.3) s vs (28.2 ± 5.2) s and (234.8 ± 24.0) s vs (265.2 ± 21.0) s, P < 0.05]. There was no significant difference in the number of skin puncture points between the two groups (P > 0.05). The number of the changes of the needle direction in group O was significantly less than that in group S (P < 0.05). There were 0 cases of arterial puncture in group O and 3 in group S. There were no hemothorax and pneumothorax in the two groups. Conclusion Right internal jugular vein catheterization guided by ultrasound in obese patients underwent laparoscopic surgery is safe and reliable with high first-time successful rate of puncture. Compared with the short axis plane method, oblique axis plane method can shorten the time of puncture and catheterization, reduce the number of the changes of the needle direction and the risk of common carotid artery puncture.