静脉靠解剖 动脉靠手摸
平面内 & 平面外
技术在国内外的应用和准入情况
• 超声引导下血管穿刺，在临床上已经有十多年的使用经 验，根据发表的文章及指南，与基于体表标记的方法相 比较，在中心静脉穿刺期间使用超声引导，产生的并发 症更少，成功插入套管的尝试次数更少，过程持续时间 更短且操作的失败次数更少。因此，美国医疗保健研究 与质量局（ＡＨＲＱ）和英国临床优化研究所（ＮＩＣ Ｅ） 已发布了声明，提倡超声引导下进行静脉插管操 作。
超声引导下动静脉穿刺置管
技术原理
• 超声引导置管（Ultrasoundguided cannulation）被定义为 在针穿刺皮肤之前用超声扫描来 确定针的存在及其位置，然后进 行即时的超声引导的血管穿刺过 程。超声协助置管（Ultrasoundassisted cannulation）是指在 没有超声即时引导的情况下，用 针穿刺之前，用超声扫描来确定 目标血管的存在及其位置。超声 血管内定位（Ultrasound verification of intravascular placement）是用超声成像描述来 确定导引钢丝和导管在目标血管 内的正确位置。
Backgroud
Arterial cannulation may be very difficult and time-consuming in severe trauma patients with palpation method due to weak pulse. Complications were relate to multiple attempts to cannulate the artery. The purpose of this study was to establish a new artery cannulate method with ultrasound guided, avoiding traditional going through and draw backtechnique. compare ultrasound guided versus traditional palpation placement of arterial lines for time to placement, number of attempts, sites used.
A new Ultrasound-guided Arterial Cannulation Method in Sever Trauma Improve Success Rate
Hai-Bo Song, M.M, Xin-Chuan Wei, M.D., Wei Wei, M.D., Jin Liu, M.D. Departmeal, Sichuan University, Chengdu, Sichuan 610041, China
Methods
This was a prospective, randomized study at a tertiary university hospital. Inclusion criteria were severe trauma adult patients requiring arterial catheter insertion for intraoperative monitoring. Patients were randomized to 2 groups, group1 used ultrasound imaging to guiding arterial cannulation,group 2 used traditional palpation method.U-test,Wilcoxon signed rank sum test were used for statistical analysis.
Results
In our study ,we establish a new ultrasound guidence method for artery cannulate by using a saline-filled balloon.The image quality of the radial artery and artery line was improved. 26 adult patients were enrolled in our study, ultrasound-guided cannulate was success in all patients of
Group 1 compared to only 10of 13 (76.9%) patients in Group 2;all the patients of Group1 selected
radial artery for cannulation,In Group2 radial ,brachial or femoral artery were selected. Fewer attempts with the ultrasound guidengce were required than with the traditional technique (14vs 24, P < 0.05). ultrasound group had a shorter time required for catheter insertion (57+/- 86 secs vs.306 +/-316secs,p=0.0006)
• 2002年9月英国临床技术研究院将超声引导 中心静脉置管作为标准方法在全国推广
超声引导纳入操作规范
Alan S. Graham, M.D.et.al. N Engl J Med 2007;356:e21.
美国超声心动图学会和心血管麻醉医师协会联合出台了 《2011ASE/SCA 超声引导下血管插管指南》