中心静脉置管在危重病人抢救中的应用
作者：朱彦君 王凤杰 申圣 高跃闽 刘东宁
单位：朱彦君 王凤杰 申圣 高跃闽(大庆市第四医院外科)；刘东宁(明水县人民医院外科)
关键词：
中国临床营养杂志000163摘 要：目的报告该院自1992年以来，在危重病人抢救时采用中心静脉穿刺置管，快速建立输液的静脉通道216例的体会。 方法置管途径：经右侧颈内静脉至上腔静脉97例，经右侧锁骨下静脉至上腔静脉110例，经左侧锁骨下静脉6例，经股静脉至下腔静脉3例。置管并发症：少量气胸3例，占1.4%(3/213)；误穿动脉2例占0.9%(2/216)；导管头端异位2例，占观察病例的4.7%(2/42)；左侧股部皮下血肿1例(1/3)。置管操作时间在3～15分钟，大部分在7分钟左右。 结果中心静脉置管方法简便、快速，并能将导管直接送入较粗的静脉，同一条静脉能反复穿刺，多次使用，虽具有一定盲目性，但只要操作者熟练掌握这一技术，仍是安全可靠的。且中心静脉管径粗，血流速度快，血流量大，经中心静脉输液不受输入液浓度与速度的限制。同时为病人后期进一步治疗如静脉营养提供了通道。 结论首先要严格掌握穿刺置管的适应症。其次对于清醒病人要在穿刺前讲清穿刺置管的必要性和注意事项，争取病 人配合。最重要的一点是操作时必须严肃认真，严格执行操作规程和操作要点，熟悉局部组织解剖结构，掌握各血管走行和毗邻关系，操作应有专人负责。
, 百拇医药
Application of central venous catheter(CVC) in rescuing life threatening patients
ZHU Yanjun ,WANG Fengjie ,SHEN Sheng
(Surgical Department, Fourth Hospital of Daqing)
Abstract： This article reports the experience of 216 cases applying CVC and getting a rapid path for fluid infusion in rescuing life-threatening patients since 1992. Vascular Access: Of 216 cases, 97 patients were put CVC by the right side of internal jugular venous up to superior yens eava, 110by the right side of subclavian vein up to superior vena cava, 6 by the left side of subclavian vein, 3 by fermoral vein up to inferior vena cava. Complications: Of 216 cases, 3 with a little pneumatothorax (1.4%), 2 with misarteriopuncture (0.9%), of 42 observational cases, 2 catheter end dystopia (4.7). Of 3 same kind of cases, 1 with left thigh subcutaneous heraatoma (33). Operating time was between 3～15 minutes and most of them were about 7 min. Most of the life-threatening patients were eompanied with shock, so, the most important thing to do for antishock is to get a rapid path of fluid infusion. The application of central venous catheter can solve many clinical problems, and the methord is simple rapid and the catheter can be put right into thicker vein which can be repeated used (injected). If the operator is skilled for the methord, it's safe and reliable. At the same time, it can provide a path for vein nutrition in the future treatment. Complications prevention: At first, the doctors must know the indications for central venous catheter strictly. Secandly, try to get the patients cooperation before the central venous catheter. Especially, for the patients in waking state, the most important is that the operator must grasp the techniques and execute the operating rules and know the structure of local histological dissection well. Therefore, the complilcations can be reduced with the central venous catheter and many patients can survive., 百拇医药
单位：朱彦君 王凤杰 申圣 高跃闽(大庆市第四医院外科)；刘东宁(明水县人民医院外科)
关键词：
中国临床营养杂志000163摘 要：目的报告该院自1992年以来，在危重病人抢救时采用中心静脉穿刺置管，快速建立输液的静脉通道216例的体会。 方法置管途径：经右侧颈内静脉至上腔静脉97例，经右侧锁骨下静脉至上腔静脉110例，经左侧锁骨下静脉6例，经股静脉至下腔静脉3例。置管并发症：少量气胸3例，占1.4%(3/213)；误穿动脉2例占0.9%(2/216)；导管头端异位2例，占观察病例的4.7%(2/42)；左侧股部皮下血肿1例(1/3)。置管操作时间在3～15分钟，大部分在7分钟左右。 结果中心静脉置管方法简便、快速，并能将导管直接送入较粗的静脉，同一条静脉能反复穿刺，多次使用，虽具有一定盲目性，但只要操作者熟练掌握这一技术，仍是安全可靠的。且中心静脉管径粗，血流速度快，血流量大，经中心静脉输液不受输入液浓度与速度的限制。同时为病人后期进一步治疗如静脉营养提供了通道。 结论首先要严格掌握穿刺置管的适应症。其次对于清醒病人要在穿刺前讲清穿刺置管的必要性和注意事项，争取病 人配合。最重要的一点是操作时必须严肃认真，严格执行操作规程和操作要点，熟悉局部组织解剖结构，掌握各血管走行和毗邻关系，操作应有专人负责。
, 百拇医药
Application of central venous catheter(CVC) in rescuing life threatening patients
ZHU Yanjun ,WANG Fengjie ,SHEN Sheng
(Surgical Department, Fourth Hospital of Daqing)
Abstract： This article reports the experience of 216 cases applying CVC and getting a rapid path for fluid infusion in rescuing life-threatening patients since 1992. Vascular Access: Of 216 cases, 97 patients were put CVC by the right side of internal jugular venous up to superior yens eava, 110by the right side of subclavian vein up to superior vena cava, 6 by the left side of subclavian vein, 3 by fermoral vein up to inferior vena cava. Complications: Of 216 cases, 3 with a little pneumatothorax (1.4%), 2 with misarteriopuncture (0.9%), of 42 observational cases, 2 catheter end dystopia (4.7). Of 3 same kind of cases, 1 with left thigh subcutaneous heraatoma (33). Operating time was between 3～15 minutes and most of them were about 7 min. Most of the life-threatening patients were eompanied with shock, so, the most important thing to do for antishock is to get a rapid path of fluid infusion. The application of central venous catheter can solve many clinical problems, and the methord is simple rapid and the catheter can be put right into thicker vein which can be repeated used (injected). If the operator is skilled for the methord, it's safe and reliable. At the same time, it can provide a path for vein nutrition in the future treatment. Complications prevention: At first, the doctors must know the indications for central venous catheter strictly. Secandly, try to get the patients cooperation before the central venous catheter. Especially, for the patients in waking state, the most important is that the operator must grasp the techniques and execute the operating rules and know the structure of local histological dissection well. Therefore, the complilcations can be reduced with the central venous catheter and many patients can survive., 百拇医药