Crit Care Med:超声引导下中心静脉导管定位及对气胸的排除

2017-06-20 MedSci MedSci原创

尽管实时超声引导下中心静脉穿刺已经成为ICU的一种标准操作,然而穿刺后的胸片检查仍然是确认中心静脉导管位置及排除像气胸等肺部并发症的金标准。但是我们推测对于中心静脉穿刺定位及排除气胸,经胸心脏超声及肺部超声并不逊色于胸片。

尽管实时超声引导下中心静脉穿刺已经成为ICU的一种标准操作,然而穿刺后的胸片检查仍然是确认中心静脉导管位置及排除像气胸等肺部并发症的金标准。但是我们推测对于中心静脉穿刺定位及排除气胸,经胸心脏超声及肺部超声并不逊色于胸片。

研究对象为医院里所有手术室、手术及外科ICU超声引导下进行锁骨下或颈内静脉穿刺术的患者。试验设计采取单中心非劣性前瞻性研究。

在超声引导下确定中心静脉穿刺点,超声实时检测下置入导丝,探头于剑突下四心腔视野确定导管是否达到右心房。穿刺后根据肺脏M-型排除是否发生气胸。

共有137名患者参与并产生有效数据。胸片排除了137名患者气胸的发生(100%),肺部超声扫描了137名患者中的123名,有效的排除了这123名患者中的气胸的发生(100%)。胸片在137名患者中成功定位了136名患者的导管穿刺点(99.3%),13名患者可接受剑突下四心腔视野,在超声组,124名患者中有121名经超声准确定位了穿刺点。

综上所述可得出结论:经胸超声心动图及肺部超声在中心静脉穿刺定位上并不逊色于胸部X线。因此,超声定位穿刺点可有效的减少穿刺所需时间,降低对射线的暴露,同时可提高患者的舒适度。

原始出处:Amir R1, Knio ZO, Mahmood F,et al. Ultrasound as a Screening Tool for Central Venous Catheter Positioning and Exclusion of Pneumothorax. Crit Care Med. 2017 Jul;45(7):1192-1198. doi: 10.1097/CCM.0000000000002451.

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  5. 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  6. 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  7. 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content=学习了,涨知识了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDM9swhbgTo7nzqRKzMmzckmEoeTyLQVDCgjqsicjyhxPs0vPoYU6GsSYbCjSkNHicJkz3NL0a0EbUMVdNjkctXI6FocpGKaVr9E/0, createdBy=29392048316, createdName=王秀, createdTime=Tue Jun 20 21:55:20 CST 2017, time=2017-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=213235, encodeId=ec42213235f6, content=学习了,谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Tue Jun 20 21:36:05 CST 2017, time=2017-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=213217, encodeId=c4f721321e78, content=这个很好,应用方便安全, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=387d1660055, createdName=dhzzm, createdTime=Tue Jun 20 20:38:08 CST 2017, time=2017-06-20, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1697485, encodeId=a7c9169e4857f, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Mon Feb 12 18:55:00 CST 2018, time=2018-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1796977, encodeId=71f31e96977d6, content=<a href='/topic/show?id=5a6e221853a' target=_blank style='color:#2F92EE;'>#中心静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22185, encryptionId=5a6e221853a, topicName=中心静脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8f4110, 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channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63855, encryptionId=ee95638550d, topicName=气胸)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4b0f4898732, createdName=12498c32m69暂无昵称, createdTime=Thu Jun 22 08:55:00 CST 2017, time=2017-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1607685, encodeId=a419160e68521, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Thu Jun 22 08:55:00 CST 2017, time=2017-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=213239, encodeId=fe4d21323921, content=学习了,涨知识了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDM9swhbgTo7nzqRKzMmzckmEoeTyLQVDCgjqsicjyhxPs0vPoYU6GsSYbCjSkNHicJkz3NL0a0EbUMVdNjkctXI6FocpGKaVr9E/0, createdBy=29392048316, createdName=王秀, createdTime=Tue Jun 20 21:55:20 CST 2017, time=2017-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=213235, encodeId=ec42213235f6, content=学习了,谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Tue Jun 20 21:36:05 CST 2017, time=2017-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=213217, encodeId=c4f721321e78, content=这个很好,应用方便安全, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=387d1660055, createdName=dhzzm, createdTime=Tue Jun 20 20:38:08 CST 2017, time=2017-06-20, status=1, ipAttribution=)]
    2017-06-20 王秀

    学习了,涨知识了!

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1697485, encodeId=a7c9169e4857f, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Mon Feb 12 18:55:00 CST 2018, time=2018-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1796977, encodeId=71f31e96977d6, content=<a href='/topic/show?id=5a6e221853a' target=_blank style='color:#2F92EE;'>#中心静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22185, encryptionId=5a6e221853a, topicName=中心静脉)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8f4110, 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channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63855, encryptionId=ee95638550d, topicName=气胸)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4b0f4898732, createdName=12498c32m69暂无昵称, createdTime=Thu Jun 22 08:55:00 CST 2017, time=2017-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1607685, encodeId=a419160e68521, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Thu Jun 22 08:55:00 CST 2017, time=2017-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=213239, encodeId=fe4d21323921, content=学习了,涨知识了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDM9swhbgTo7nzqRKzMmzckmEoeTyLQVDCgjqsicjyhxPs0vPoYU6GsSYbCjSkNHicJkz3NL0a0EbUMVdNjkctXI6FocpGKaVr9E/0, createdBy=29392048316, createdName=王秀, createdTime=Tue Jun 20 21:55:20 CST 2017, time=2017-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=213235, encodeId=ec42213235f6, content=学习了,谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Tue Jun 20 21:36:05 CST 2017, time=2017-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=213217, encodeId=c4f721321e78, content=这个很好,应用方便安全, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=387d1660055, createdName=dhzzm, createdTime=Tue Jun 20 20:38:08 CST 2017, time=2017-06-20, status=1, ipAttribution=)]
    2017-06-20 1e145228m78(暂无匿称)

    学习了,谢谢作者分享!

    0

  10. 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channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63855, encryptionId=ee95638550d, topicName=气胸)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4b0f4898732, createdName=12498c32m69暂无昵称, createdTime=Thu Jun 22 08:55:00 CST 2017, time=2017-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1607685, encodeId=a419160e68521, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Thu Jun 22 08:55:00 CST 2017, time=2017-06-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=213239, encodeId=fe4d21323921, content=学习了,涨知识了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDM9swhbgTo7nzqRKzMmzckmEoeTyLQVDCgjqsicjyhxPs0vPoYU6GsSYbCjSkNHicJkz3NL0a0EbUMVdNjkctXI6FocpGKaVr9E/0, createdBy=29392048316, createdName=王秀, createdTime=Tue Jun 20 21:55:20 CST 2017, time=2017-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=213235, encodeId=ec42213235f6, content=学习了,谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Tue Jun 20 21:36:05 CST 2017, time=2017-06-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=213217, encodeId=c4f721321e78, content=这个很好,应用方便安全, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=387d1660055, createdName=dhzzm, createdTime=Tue Jun 20 20:38:08 CST 2017, time=2017-06-20, status=1, ipAttribution=)]
    2017-06-20 dhzzm

    这个很好,应用方便安全

    0