医学超声引导下动静脉穿刺置管专题课件VIP免费

超声引导下动静脉穿刺置管技术原理•超声引导置管（Ultrasound-guidedcannulation）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（Ultrasound-assistedcannulation）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（Ultrasoundverificationofintravascularplacement）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。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（ＮＩＣＥ）已发布了声明，提倡超声引导下进行静脉插管操作。•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AlanS.Graham,M.D.et.al.NEnglJMed2007;356:e21.超声引导纳入操作规范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》AnewUltrasound-guidedArterialCannulationMethodinSeverTraumaImproveSuccessRateAnewUltrasound-guidedArterialCannulationMethodinSeverTraumaImproveSuccessRateAnewUltrasound-guidedArterialCannulationMethodinSeverTraumaImproveSuccessRateAnewUltrasound-guidedArterialCannulationMethodinSeverTraumaImproveSuccessRateHai-BoSong,M.M,Xin-ChuanWei,M.D.,WeiWei,M.D.,JinLiu,M.D.DepartmentofAnesthesiology,WestChinaHospital,SichuanUniversity,Chengdu,Sichuan610041,ChinaBackgroudArterialcannulationmaybeverydifficultandtime-consuminginseveretraumapatientswithpalpationmethodduetoweakpulse.Complicationswererelatetomultipleattemptstocannulatetheartery.Thepurposeofthisstudywastoestablishanewarterycannulatemethodwithultrasoundguided,avoidingtraditionalgoingthroughanddrawbacktechnique.compareultrasoundguidedversustraditionalpalpationplacementofarteriallinesfortimetoplacement,numberofattempts,sitesused.MethodsThiswasaprospective,randomizedstudyatatertiaryuniversityhospital.Inclusioncriteriawereseveretraumaadultpatientsrequiringarterialcatheterinsertionforintraoperativemonitoring.Patientswererandomizedto2groups,group1usedultrasoundimagingtoguidingarterialcannulation,group2usedtraditionalpalpationmethod.U-test,Wilcoxonsignedranksumtestwereusedforstatisticalanalysis.ConclusionsInthisstudy,anewultrasoundguidencemethodforarterycannulatewasestablished,ultrasoundimageofradialarteryandarterylinewasimprovedbyasaline-filledballoon(figure1,2).Comparedwiththepalpationmethod,thesuccessrateofultrasoundguidanceforarterialcannulationwashigher.Arteriallineinsertiontooklesstimeinultrasoundguidencegroup.Severtraumapatientcouldsharebenifitfromulrasoundguidencearterycannulate.ResultsInourstudy,weestablishanewultrasoundguidencemethodforarterycannulatebyusingasaline-filledballoon.Theimagequalityoftheradialarteryandarterylinewasimproved.26adultpatientswereenrolledinourstudy,ultrasound-guidedcannulatewassuccessinallpatientsofGroup1comparedtoonly10of13(76.9%)patientsinGroup2;allthepatientsofGroup1selectedradialarteryforcannulation,InGroup2radial,brachialorfemoralarterywereselected.Fewerattemptswiththeultrasoundguidengcewererequiredthanwiththetraditionaltechnique(14vs24,P<0.05).ultrasoundgrouphadashortertimerequiredforcatheterinsertion(57+/-86secsvs.306+/-316secs,p=0.0006)技术的安全性、有效...