国际麻醉学与复苏杂志   2014, Issue (3): 10-10
    
锁骨下静脉置管误入同侧颈内静脉的危险因素分析
邢顺鹏, 皋源, 闻大翔, 何征宇, 杭燕南1()
1.上海交通大学医学院附属仁济医院
The analysis on risk factors of misplacement of subclavian venous catheterization into ipsilateral internal jugular vein
 全文:
摘要：

[摘要] 目的 探讨锁骨下静脉置管误入同侧颈内静脉的危险因素。方法 收集2011年1月至2012年12月间上海交通大学医学院附属仁济医院外科监护室行锁骨下静脉置管成功的患者178例，均采用Seldinger技术进行置管。记录患者性别、年龄、穿刺部位、穿刺位点、进针方向、穿刺针针尖斜面方向、导引钢丝J型头方向、穿刺时头部位置，先以单因素分析筛选出有统计学意义的危险因素，再应用多因素非条件logistic回归分析患者在锁骨下静脉置管进入颈内同侧颈内静脉的独立危险因素。结果 单因素分析表明：锁骨下静脉置管是否进入同侧颈内静脉与患者的性别(P=0.504)、年龄(P=0.200)、进针方向 (P=0.370)、穿刺针针尖斜面方向(P=0.670)无关，与穿刺部位(P=0.012)、穿刺位点（P=0.012）、穿刺时导引钢丝J型头方向（P=0.000）、穿刺时患者头部位置（P=0.030）有关。多因素回归分析显示：锁骨下静脉置管时穿刺部位在右侧〔危险度比值比（OR）=55.373，95%可信区间（CI）：5.145～595.845，X2=10.965， P=0.001〕、导引钢丝J型头朝向颈内静脉（OR=24.116，95% CI:6.848～84.918，X2=24.558， P=0.000）和穿刺时头部偏向穿刺对侧（OR=3.681，95% CI:1.210～11.199，X2=5.268， P=0.022），为锁骨下静脉置管误入同侧颈内静脉的独立危险因素。共29例（16.29%）患者锁骨下静脉置管时进入同侧颈内静脉。结论 锁骨下静脉置管误入同侧颈内静脉是其常见的并发症，影响锁骨下静脉置管误入同侧颈内静脉的主要因素有穿刺部位选择右侧、导引钢丝J型头朝向颈内静脉、穿刺时头部偏向穿刺对侧。
关键词： 锁骨下静脉置管；颈内静脉；危险因素；logistic回归分析；
Abstract:

[Abstract] Objective：To identify the risk factors of misplacement of subclavian vein catheterization (SVC) into ipsilateral internal jugular vein(IJV). Methods：From January 2011 to December 2012, subclavian vein catheterization was successfully performed with Seldinger method in 178 patients in Department of Surgical intensive care unit, Renji Hospital Affiliate of Shanghai Jiaotong University Medical School.The patients’ sex、age、paracentesis side、paracentesis site、direction of puncture needle,、direction of puncture needle bevel、Direction of the J-Tip of the guidewire、position of the head during puncture were recorded.They were subjected to single factor analysis,then independent risk factors were determined with multivariate stepwise non-conditional logstic regression analysis of subclavian venous catheterization into ipsilateral internal jugular vein. Results: single factor analysis showed that subclavian venous catheterization into ipsilateral internal jugular vein had no relation with sex(P=0.504)、age(P=0.504)、paracentesis site（P=0.012）、direction of puncture needle(P=0.370)、direction of puncture needle bevel(P=0.670),but had relation with paracentesis side(P=0.012)、paracentesis site(P=0.012)、direction of the J-Tip of the guidewire（P=0.000）、position of the patient head（P=0.030）.Multivariate stepwise non-conditional logistic regression analysis showed that on the right side of subclavian venous catheterization〔odds ratio(OR)=55.373，95% confidence interval（CI）:5.145～595.845，X2=10.965， P=0.001〕、J-Tip of the guidewire toward to internal jugular vein（OR=24.116，95% CI:6.848～84.918，X2=24.558， P=0.000）、the head to the contralateral of puncture（OR=3.681，95% CI:1.210～11.199，X2=5.268， P=0.022）were independent factors. A total of 29 cases ( 16.29% ) of patients entered ipsilateral internal jugular vein during subclavian venous catheterization. Conclusion: catheter misplacement into the ipsilateral internal jugular vein is common with the subclavian venous catheterization.The risk factor of the catheter misplacement into ipsilateral internal jugular vein are on the right side of subclavian venous catheterization、J-Tip of the guidewire toward to internal jugular vein、the head to the contralateral of puncture.
Key words: Subclavian Venous catheterization; Internal Jugular Vein; Risk factor; logisticregression analysis;