动脉搏动指导和解剖标志指导穿刺颈内静脉方法的比较

为对动脉搏动和解剖标志指导穿刺颈内静脉的两种方法进行比较，对５９８例患者颈内静脉穿刺的结果及并发症进行分析。前２１３例采用动脉搏动指导穿刺法，后３８５例采用解剖标志指导穿刺法。结果表明：解剖标志指导穿刺法的总穿刺和一次穿刺成功率均显著高于动脉搏动指导穿刺法（９９．２％ｖｓ９５．７％、８３．８％ｖｓ７３．７％，Ｐ＜０．０５和＜０．０１），而平均穿刺次数和时间前者明显少于后者（１．２±０．５次ｖｓ２．７±２．９次、１．９±５．３ｍｉｎｖｓ３．１±４．７ｍｉｎ，Ｐ均＜０．０５）；两种穿刺方法的并发症发生率分别为３．４％和１１．７％（Ｐ＜０．０１），主要并发症为误穿颈总动脉（８．０％ｖｓ２．１％，Ｐ＜０．０１），２例血胸均发生于动脉搏动指导穿刺法。提示解剖标志指导穿刺法可提高穿刺成功率和减少并发症的发生。

A Comparison of Internal Jugular Venipuncture Techniques Guided by Arterial Pulse to Anatomic Landmark

In this study the internal jugular venipuncture was performed in 598 patients,and the results of venipuncture guided by arterial pulse in the first 213 patients were compared with those in the last 385 patients in whom the internal jugular vein was cannulated with anatomic landmark guidance.The results showed that both total success rate and first attempt success rate of using anatomic landmark guidance were significantly higher than using arterial pulse guidance (99.2% vs 95.7%,83.8% vs 73.7%, P <0.05 and <0.01 respectively);however average puncture number and procedure time were obviously lower in the anatomic landmark group than in the arterial pulse group (1.2±0.5 vs 2.7±2.9 times,1.9±5.3 vs 3.1±4.7 min,both P <0.05).Although the most frequent complication associated with internal jugular venipuncture was puncture of general carotid artery in this study (65.8%,25/38),the complication rates were 3.4% of patients in anatomic landmark group and 11.7% of patients in arterial pulse group ( P <0.01).Two cases with hemothorax occurred when aterial pulse guided technique was used.It is suggested that the internal jugular venipuncture techniques guided by anatomic landmark can improve success rate and reduce complication rate.