Application of ultrasound-guided axillary venous puncture and catheterization in obese patients
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摘要:目的 观察超声引导下腋静脉穿刺置管术在肥胖患者中应用效果。方法 选取拟行深静脉穿刺置管的肥胖患者50例，随机分为超声引导下腋静脉穿刺置管组，即观察组25例，体表定位下锁骨下静脉穿刺置管组，即对照组25例，比较2组穿刺成功率、穿刺时间、试穿次数和穿刺24 h内及1周内的并发症情况。结果 观察组穿刺成功率96.0%, 平均穿刺时间(8.2±0.8) min, 平均穿刺次数(1.2±0.8)次，首次试穿成功率68.0%, 对照组穿刺成功率72.0%, 平均穿刺时间(17.2±1.9) min, 平均穿刺次数(2.4±0.2)次，首次试穿成功率28.0%, 2组比较差异有统计学意义(P<0.05); 观察组穿刺后24 h内误伤动脉与血肿发生率低于对照组，且观察组穿刺1周内穿刺点渗血发生率低于对照组, 差异有统计学意义(P<0.05)。结论 超声引导下腋静脉穿刺置管较体表定位下锁骨下静脉穿刺置管更加高效安全。Abstract:Objective To observe the application effect of ultrasound-guided axillary venous puncture and catheterization in obese patients.Methods Fifty obese patients with deep venous puncture and catheterization were randomly divided into observation group (treated with ultrasound-guided axillary venous puncture and catheterization) and control group (treated with subclavian venous puncture and catheterization under body surface positioning), with 25 cases in each group. Successful rate of puncture, puncture time, times of attempted puncture and complications within 24 hours and 1 week after puncture were compared between the two groups.Results In the observation group, the successful rate of puncture was 96.0%, the average puncture time was (8.2±0.8) minutes, the average times of puncture was (1.2±0.8), and the successful rate of the first attempted puncture was 68.0%; the successful rate of puncture in the control group was 72.0%, the average puncture time was (17.2±1.9) minutes, the average times of puncture was (2.4±0.2), and the successful rate of the first attempted puncture was 28.0%; there were significant differences in indexes mentioned above between two groups (P<0.05). The incidence rates of accidental arterial injury and hematoma within 24 hours after puncture in the observation group were significantly lower than those in the control group, and the incidence rate of bleeding at the puncture point within 1 week after puncture in the observation group was significantly lower than that in the control group (P<0.05).Conclusion Ultrasound-guided axillary venous puncture and catheterization is more effective and safer than subclavian venous puncture and catheterization under body surface positioning.
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Keywords:
- ultrasound /
- axillary vein /
- central venous catheterization /
- obese patients
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表 1 2组患者穿刺时间、次数和成功率比较(x±s)
组别 穿刺时间/min 穿刺次数/次 首次穿刺成功率/% 总体成功率/% 对照组(n=25) 17.2±1.9 2.4±0.2 28.0 72.0 观察组(n=25) 8.2±0.6* 1.2±0.8* 68.0* 96.0* 与对照组比较, *P<0.05。 
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表 2 2组患者穿刺后24 h内并发症发生情况比较[n(%)]
组别 误伤动脉 血肿 神经损伤 导管未置入上腔静脉 导管堵塞 气胸 导管相关性感染 对照组(n=25) 7(28.0) 4(16.0) 0 1(4.0) 0 0 0 观察组(n=25) 1(4.0)* 1(4.0)* 0 1(4.0) 0 0 0 与对照组比较, *P<0.05。
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表 3 2组患者穿刺后1周内并发症发生情况比较[n(%)]
组别 穿刺点渗血 穿刺点红肿 血肿 神经损伤 导管堵塞 导管脱落 导管相关性感染 对照组(n=25) 4(16.0) 3(12.0) 4(16.0) 0 2(8.0) 0 0 观察组(n=25) 1(4.0)* 2(8.0) 1(4.0)* 0 3(12.0) 0 0 与对照组比较, *P<0.05。
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