ARDS患者俯卧位行超声引导下颈内静脉置管术的临床应用分析
Clinical analysis on the application of ultrasound-guided internal jugular vein catheterization in patients with ARDS in the prone position
王熙宇 1廖芮 1黄煜 1王玺 1余红 1刘旭阳2
作者信息
- 1. 西南交通大学附属医院(成都市第三人民医院)重症医学科(成都,610031)
- 2. 西南交通大学附属医院(成都市第三人民医院)急诊科
- 折叠
摘要
目的:中重度急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者通常需要施行中心静脉置管术(central venous catheterization,CVC).但对于此类患者治疗必不可少的俯卧位,使得CVC操作难度大幅增加,超声引导技术能够使俯卧位下的CVC在技术上具备可行性.方法:回顾性分析2022年5月-2023年5月在西南交通大学附属医院(成都市第三人民医院)重症监护室接受有创机械通气及俯卧位通气的39例中重度ARDS患者的临床资料及颈内静脉置管特征,旨在探究实时超声引导下的CVC在处于俯卧位、接受有创机械通气的中重度ARDS患者中的可行性.主要结果为首次穿刺成功率;次要结果包括置管成功率以及穿刺次数、总置管时间.结果:首次穿刺成功率为84.6％;置管成功率为92.3％;穿刺次数中位数为1;导管插入总时间为106.4(89.2～137.9)s;1例(2.6％)出现动脉穿刺,1例(2.6％)出现皮下血肿;未发生气胸、血胸、导管错位.结论:在重症监护室中,对处于深度镇静状态的有创机械通气且呈俯卧位的中重度ARDS患者进行实时超声引导下的颈内静脉置管术,是可行且安全的.
Abstract
Objective:Central venous catheterization(CVC)is often required for moderate and severe acute re-spiratory distress syndrome(ARDS)patients.However,the prone position,which is essential for treating such patients,significantly increases the difficulty of CVC.We suggest that ultrasound(US)-guided CVC in the prone position is technically feasible.Methods:A retrospective analysis was performed on the clinical characteristics of internal jugular vein catheterization of 39 patients with moderate and severe ARDS who received invasive mechani-cal ventilation and prone positioning in the general ICU of the Third people's Hospital of Chengdu from May 2022 to May 2023,with the aim of exploring the feasibility of real-time US-guided internal jugular catheterizaiton in moderate and severe ARDS patients in the prone position.The primary outcome was the first-attempt success rate.The secondary outcomes were the success rate,number of attempts and total catheterization time.Results:The first-attempt success rate was 84.6％.The catheterization success rate was 92.3％.The median number of attempts was 1.The total catheterizaition time was 106.4 s(89.2,137.9).Arterial puncture occurred in one pa-tient(2.6％),and one patient(2.6％)developed a haematoma.No pneumothorax,hemothorax,or catheter mis-placement was noted.Conclusion:Real-time US-guided internal jugular catheterization in ARDS patients under in-vasive mechanical ventilation and deep sedation in the prone position in the ICU is feasible and safe.
关键词
超声/颈内静脉置管术/俯卧位/急性呼吸窘迫综合征/重症监护室Key words
ultrasound/internal jugular venous catheterization/prone position/acute respiratory distress syndrome/intensive care unit引用本文复制引用
出版年
2024
NETL
NSTL
万方数据