【摘要】 目的探讨婴儿锁骨中点内侧锁骨上进路行锁骨下静脉穿刺中心静脉置管的可行性。方法行大手术婴儿共150例,男88例,女62例,年龄1～12月,体重2.9～9.4kg,随机分为3组,每组50例。Ⅰ组采用锁骨中点内侧锁骨上进路；Ⅱ组采用 Yoffa 进路；Ⅲ组采用改良 James 进路。记录总穿刺置管成功率、首次试穿成功率、失败率、进针深度、穿刺成功时间、置管完成时间及并发症发生情况。结果三组总穿刺成功率、穿刺成功时间、置管完成时间、失败率差异无统计学意义(P＞ 0.05)。Ⅰ组首次试穿成功率为86%,高于Ⅱ组(74%)和Ⅲ组(80%)(P＜0.05)。Ⅰ组进针深度 [(2.21±0.28)cm]深于Ⅱ组[(1.79±0.33)cm]和Ⅲ组[(1.84±0.38)cm](P＜0.05)。三组均无气胸、误穿动脉、神经损伤等并发症发生。结论婴儿经锁骨中点内侧锁骨上进路行锁骨下静脉穿刺中心静脉置管法,具有高成功率和安全性,是可行的。更多还原

【Abstract】 Objective To evaluate the effectiveness and safety of percutaneous subclavian venous catheterization through the point of insertion medial to the middle of clavicle in infants.Methods One hundred and fifty infants(88 male,62 female)aged 1-12 months scheduled for major operation were enrolled in this study. Subclavian venous catheterization was performed via supraclavicular approach.The needle was inserted at a point midway between the middle of clavicle and the inner third of clavicle(group Ⅰ,n=50)or at the point where the posterior border of sterno-cleidomastoid muscle(SCM)meets the upper border of clavicle(Yoffa method group Ⅱ, n=50)or at the posterior border of SCM,0.5-1.0 cm above the upper border of clavicle(modified James method,group Ⅲ,n=50).The overall success rate,the success rate at first attempt,the failure rate,the depth of insertion and complications were recorded.Results The 3 groups were comparable with respect to sex ratio,age and body weight.There were no significant differences in overall success rate and failure rate among the 3 groups. The success rate at first attempt in group Ⅰ(86%)was significantly higher than that in group Ⅱ(74%)and group Ⅲ(80%)(P＜0.05).The depth of insertion was significantly greater in group Ⅰ[(2.21+0.28)cm]than in group Ⅱ[(1.79±0.33)cm]and group Ⅲ[(1.84±0.38)cm].No pneumothorax and in advertent arterial puncture and nerve injury occurred in the 3 groups.Conclusion Supraclaricular subclavian venous catheterization through the insertion point medial to the middle of clavicle is better than the conventional methods(Yoffa,James) in terms of success rate at first attempt in infants.更多还原