摘要目的 评价超声预定位四点法用于出血高危产妇右颈内静脉穿刺置管术的效果.方法 拟在全身麻醉下行剖宫产术的凶险型前置胎盘产妇80例,ASA分级Ⅰ或Ⅱ级,年龄25～38岁,体重60～90 kg,采用随机数字表法分为2组(n=40):实时超声引导组(UG组)和超声预定位四点法组(FU组).UG组实时超声引导下行右颈内静脉置管术:移动超声探头,使右颈内静脉的横截面图像中线与超声显示屏中线相重叠,选颈内静脉中线和环状软骨水平线的交叉点作为穿刺点.FU组采用超声预定位四点法行右颈内静脉置管术:移动超声探头,使右颈内静脉横截面图像中线与超声显示屏中线相重叠,将探头长轴中点所在皮肤标记为A点;向内侧横移探头使其内侧缘切线与超声显示屏中线相重叠,在探头长轴中点所在皮肤标记为B点,即穿刺点;于右颈内静脉近心端,距B点2 cm处作一标记为C点,距A点2 cm处作一标记为D点,即指示点(穿刺进针方向);在B点行局部浸润麻醉后,使用穿刺针向D点穿刺.记录穿刺成功情况、置管成功情况、置管操作时间以及血肿、误入动脉、血气胸等并发症的发生情况.结果 2组总置管成功率均为100％;与UG组比较,FU组操作时间明显缩短(P<0.01),一次穿刺成功率、一次置管成功率和误入动脉的发生率差异无统计学意义(P>0.05).结论 与实时超声引导相比,超声预定位四点法用于出血高危产妇行右颈内静脉穿刺置管术的效果更佳.

abstractsObjective To evaluate the efficacy of ultrasound-prepositioned four-point method for right internal jugular vein ( IJV) catheterization in the parturients at high risk of bleeding. Methods Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱparturients diagnosed as having perni-cious placenta previa, aged 25-38 yr, weighing 60-90 kg, scheduled for elective cesarean section under general anesthesia, were divided into 2 groups ( n=40 each) using a random number table method: real-time ultrasonic guidance group ( group UG ) and ultrasound-prepositioned four-point method group ( group UF) . In group UG, the right IJV catheterization was performed under real-time ultrasound guidance: mov-ing the ultrasonic probe to make the mid-line of the cross section image of the right IJV overlap with the mid-line of the ultrasonic display screen, and the intersection of the mid-line of the IJV and the horizontal line of the annular cartilage was selected as the puncture point. In group UF, the right IJV catheterization was per-formed by using ultrasound-prepositioned four-point method as follows: moving the ultrasonic probe to make the midline of the right IJV cross-sectional images overlap with the midline of the ultrasound display screen, and marking the skin where the midpoint of the probe's long-axis was located as point A;transversely mov-ing the probe to the inside so that the tangent line of its inner edge overlapped with the midline of the ultra-sonic display screen, marking the skin where the midpoint of the probe's long-axis was located as point B ( the puncture site);at the proximal cardiac end of the right IJV, making point C at 2 cm from point B, and making point D ( the indicator point, direction of the puncture needle) at 2 cm from point A. After lo-cal infiltration anesthesia was performed in point B, the puncture needle was inserted towards the point D. The success rate of puncture, success rate of catheterization, catheterization operation time and complica-tions such as hematoma, intravascular catheter insertion or hemopneumothorax were recorded. Results The success rate of total catheterization was 100％ in two groups. Compared with group UG, the catheteriza-tion operation time was significantly shortened ( P<0. 01) , and no significant change was found in the suc-cess rate of puncture at first attempt, success rate of catheterization at first attempt or intravascular catheter insertion in group UF ( P>0. 05) . Conclusion Compared with real-time ultrasound guidance, ultrasound-prepositioned four-point method produces better efficacy when used for the right IJV catheterization in the parturients at high risk of bleeding.