标题：超声引导下长轴及短轴法在PICC中的应用价值

      作者：叶江，阮佳泉，梁旭，李倩    (宜宾市第二人民医院超声科，四川 宜宾 644000)

      卷次： 2018年29卷9期

      【摘要】 目的 比较超声引导下长轴及短轴法在经外周静脉穿刺中心静脉置管术(PICC)中的应用价值。方法 选取宜宾市第二人民医院 2015年 1月至 2016年 12月在超声引导下行外周静脉穿刺置管患者 200例，其中超声长轴引导组100例，短轴引导组100例。比较两种超声引导法在一次穿刺成功率、穿刺成功用时、穿刺点皮下渗血或血肿发生率及导管异位发生率的差异。结果 穿刺血管内径≤3 mm的患者，长轴组一次穿刺成功率为94.3%，明显高于短轴组的75.0%，差异有统计学意义(P<0.05)；穿刺血管内径>3 mm的患者，长轴组一次穿刺成功率为100.0%，与短轴组的95.0%比较差异无统计学意义(P>0.05)；长轴组穿刺成功平均用时为(33.1±13.2) s，明显少于短轴组的(76.9±13.5) s，差异有统计学意义(P<0.05)；长轴组穿刺点皮下渗血或血肿发生率为2.0%，明显低于短轴组的 9.0%，差异有统计学意义(P<0.05)；长轴组及短轴组导管异位发生率均为 0，两组比较差异无统计学意义(P>0.05)。结论 超声长轴引导法比短轴引导法一次穿刺成功率高，穿刺成功用时少，且并发症少，可以作为超声引导外周静脉穿刺中心静脉置管的常规技术。
      【关键词】 超声引导；长轴；短轴；外周静脉穿刺；中心静脉置管术
      【中图分类号】 R654.3 【文献标识码】 A 【文章编号】 1003—6350（2018）09—1296—03

Application value of ultrasound-guided long axis and short axis approaches in peripherally inserted centralcatheter.
YE Jiang, RUAN Jia-quan, LIANG Xu, LI Qian. Department of Ultrasound, the Second People's Hospital of YibinCity, Yibin 644000, Sichuan, CHINA
【Abstract】 Objective To compare the application value of ultrasound guided long axis and short axis ap-proaches in peripherally inserted central catheter (PICC). Methods A total of 200 patients with PICC guided by ultra-sound (including 100 cases guided by long axis and 100 cases of short axis), who admitted to the Second People's Hospi-tal of Yibin city from January 2015 to December 2016, were selected and analyzed retrospectively. The one-time successrate of puncture, the average time of successful puncture, the incidence of subcutaneous errhysis and the incidence ofcatheter displacement of the two guiding methods were compared. Results When the puncture vascular diameter wasless than or equal to 3 mm, the one-time success puncture rate in long axis group (94.3%) was significantly higher thanthe short axis group (75.0%), P<0.05. When the puncture vascular diameter was greater than 3 mm, there was no statisti-cally significant difference (P>0.05) in one-time success puncture rate between the long axis group (100.0%) and theshort axis group (95.0%). For the different vascular diameters, the average time of successful puncture of the long axisgroup was (33.1±13.2) s, which was significantly less than (76.9±13.5) s of the short axis group, P<0.05; the incidenceof subcutaneous errhysis in long axis group (2.0%) was statistically less than the short axis group (9.0%) (P<0.05); andthere was no statistical significance difference in the incidence of catheter displacement between the two groups, P>0.05.Conclusion Compared with the short axis pattern guided by ultrasound, the long axis pattern has the higher successrate of puncture, fewer average time of puncture success, and less complications, which can be used as a routine technol-ogy of ultrasound-guided PICC.
      【Key words】 Ultrasound-guided; Long axis; Short axis; Peripherally inserted central catheter·临床经验·doi:10.3969/j.issn.1003-6350.2018.09.037