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目的:探讨急诊重症监护室(ICU)患者在超声定位下行深静脉置管的临床应用效果。方法:采用回顾性的分析方法对郴州市第四人民医院2013年6月至2015年3月收治的114例急诊ICU患者的临床资料进行统计分析,根据行深静脉置管时是否采用超声定位分为普通组(解剖定位法)59例、超声组55例(超声定位下进行穿刺),比较两组患者穿刺结果、治疗结果及相关并发症的发生情况差异。结果:超声组患者的穿刺时间(31.8±9.6)s、一针穿刺成功率90.91%、2针穿刺成功率100%、总成功率100%、留置导管时间(14.3±4.5)d、提前拔管率9.09%均显著的优于普通组患者,差异具有统计学意义(P<0.05)。超声组共有5例患者发生置管并发症,普通组有22例患者发生置管并发症,超声组的并发症率9.09%显著的低于普通组患者的37.29%,差异具有统计学意义(P<0.05)。超声组局部炎症发生率0%显著低于普通组的11.86%(P<0.05),超声组由于技术原因的拔管率为0.00%显著的低于普通组的8.47%(P<0.05)。超声组较快恢复率达到83.64%显著的高于普通组的50.85%(P<0.05),两组患者的死亡率比较差异不显著(P>0.05),超声组死亡患者的置管时间(31.8±5.2)d显著的长于普通组的(11.4±5.6)d(P<0.05)。结论:ICU患者在超声定位下行深静脉置管较解剖定位法具有更高的穿刺成功率,同时有利于降低置管并发症及感染,有利于促进患者的早日康复,但对死亡率影响不显著。
Objective: To investigate the clinical application of deep vein catheterization in patients with emergency intensive care unit (ICU) under ultrasound localization. Methods: A retrospective analysis was performed to analyze the clinical data of 114 ICU patients admitted to the Fourth People’s Hospital of Chenzhou City from June 2013 to March 2015. According to whether ultrasound localization points 59 cases of normal group (anatomical localization method), 55 cases of ultrasound group (puncture under ultrasound positioning), compared the two groups of patients puncture results, the treatment results and the incidence of complications related. Results: The puncture time (31.8 ± 9.6) s, the first needle puncture 90.91%, the second puncture 100%, the total success rate 100%, the catheterization time 14.3 ± 4.5 d, The rate of 9.09% was significantly better than that of the common group, the difference was statistically significant (P <0.05). A total of 5 patients in the ultrasound group had complications of catheterization. Complications of catheterization occurred in 22 patients in the general group, 9.09% in the ultrasound group was significantly lower than 37.29% in the general group (P <0.05). The incidence of local inflammation in the ultrasound group was significantly lower than that in the normal group (0% vs 11.86%, P <0.05). The extubation rate of 0.00% in the ultrasound group was significantly lower than that in the control group (8.47%, P <0.05). The fast recovery rate of ultrasound group reached 83.64%, which was significantly higher than that of general group (50.85%, P <0.05). There was no significant difference in mortality between the two groups (P> 0.05) ± 5.2) d was significantly longer than (11.4 ± 5.6) d in the normal group (P <0.05). CONCLUSIONS: The ICU patients undergoing ultrasound catheterization have a higher success rate of puncture than anatomic positioning, as well as reducing the complications and infection of catheter in ICU. It is helpful to promote the early recovery of ICU patients but has no significant effect on the mortality rate .