摘要目的 评价便携式探头无菌套膜用于超声引导中心静脉穿刺置管术的临床效果.方法 选择在超声引导下行右侧颈内静脉穿刺置管术的下肢骨折急诊患者100例,性别不限,年龄18～60岁,体重50～ 85 kg,ASA分级Ⅰ或Ⅱ,采用随机数字表法分为2组(n=50):便携式探头无菌套膜组(P组)和无菌手套组(G组).P组将超声探头置于便携式无菌套膜内,密封后用注射器抽空其内气体,使之无褶皱、无气泡贴覆于探头扫描面;G组在超声探头扫描面涂上耦合剂,用一次性医用无菌手套包裹探头.无菌化处理后对探头进行微生物学检测,以菌落总数≤5 cfu/cm2为相对无菌.记录探头无菌化处理时间、穿刺置管时间和总操作时间;记录探头扫描面和手柄的无菌化合格情况;以4分法评价超声图像清晰度,记录图像清晰(3分为清晰)情况;记录1次穿刺成功情况、1次置管成功情况和总置管成功情况;记录出血、血肿及呼吸困难等并发症的发生情况.结果 2组探头扫描面无菌化合格率均为100％;与G组比较,P组无菌化处理时间延长,穿刺置管时间和总操作时间缩短,探头手柄无菌化合格率升高,超声图像清晰率、1次置管成功率和总置管成功率均升高,出血和血肿发生率降低(P＜0.05或0.01),1次穿刺成功率差异无统计学意义(P＞0.05).结论 便携式探头无菌套膜操作简便,易实现无菌,对超声图像影响小,保证置管成功,减少并发症,适用于超声引导中心静脉穿刺置管术时探头的无菌化处理.

abstractsObjective To evaluate the clinical efficacy of portable probe sterile film used for ultrasound-guided central venous cannulation.Methods One hundred emergency patients of both sexes with lower extremity fractures prepared for ultrasound-guided right internal jugular venous cannulation,aged 18-60 yr,weighing 50-85 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,were divided into 2 groups (n=50 each) by using a random number table:portable probe sterile film group (group P) and sterile glove group (group G).In group P,the ultrasound probe was placed in the portable probe sterile film,and then the sealed film was adhered to the scanning surface without fold or bubble after emptying gas by syringe.In group G,the ultrasound probe was wrapped by disposable medical sterile gloves with the scanning surface coated by coupling agents.The microbiological detection of probe was performed after aseptic processing,and relative sterility was defined as the total number of colonies less than or equal to 5 cfu/cm2.The probe aseptic processing time,puncture and cannulation time and total operation time were recorded.The aseptic qualification of scanning surface and handle was recorded.The clarity (equal to 3 point) of ultrasonic image was assessed and recorded using a 4-point scale.The success of first puncture,first cannulation and total cannulation was recorded.Complications such as bleeding,hematoma and dyspnea were observed simultaneously.Results The aseptic qualification rate of scanning surface was all 100％ in both groups.Compared with group G,the probe aseptic processing time was significantly prolonged,the puncture and cannulation time and total operation time were shortened,the aseptic qualification rate of handle was increased,and the clarity rate of ultrasonic image and success rates of first cannulation and total cannulation were all increased,the incidence of bleeding and hematoma was decreased (P＜0.05 or 0.01),and no significant change was found in the success rate of first puncture in group P (P＞0.05).Conclusion The portable probe sterile film is easy to operate,easy to realize an aseptic condition,has limited influence on the ultrasonic imaging,also can assure successful cannulation and reduce complications,so it is suitable for aseptic processing when used for ultrasound-guided central venous cannulation.