摘要
目的 对比超声实时引导、超声辅助定位技术用于骨科手术患者外周疑难静脉穿刺效果差异。方法选择2023年12月至2024年5月收治的100例择期骨科手术患者，按抽签法随机分成观察组（n=50）、对照组（n=50）。对照组采取超声辅助定位技术进行外周疑难静脉穿刺，观察组采取超声手术引导进行外周疑难静脉穿刺。对比两组患者穿刺成功率、穿刺时间、穿刺疼痛、并发症及护理满意率。结果 观察组患者一次穿刺成功率（84.00%）与总体成功率（98.00%）与对照组（P＞0.05）相比无显著差异；观察组完成穿刺的平均时间比对照组所用的时间长，观察组患者在穿刺时的平均疼痛评分（2.12±0.36）显著低于对照组（2.99±0.46），差异具有统计学意义（P<0.05）；观察组患者的并发症发生率为4.00%，这一数值显著低于对照组，并发症的减少具有统计学上的意义（P＜0.05）；观察组的护理满意度为94.00%，高于对照组，这一增高具有统计学上的意义（P＜0.05）。结论 在进行骨科手术的患者中，当面对外周静脉穿刺难题时，使用超声技术能显著提高穿刺成功率。其中使用超声辅助定位技术时，可以缩短穿刺所需的时间。而在使用超声实时引导进行穿刺时，患者经历的疼痛更轻微，并发症更少，同时，患者对于这项操作的满意度更高。
关键词： 骨科手术；外周疑难静脉穿刺；超声实时引导；超声辅助定位技术；穿刺成功
Abstract
Objective To compare the differences in the effectiveness of real-time ultrasound guidance and ultrasound assisted localization techniques for peripheral difficult vein puncture in orthopedic surgery patients. Method: 100 patients undergoing elective orthopedic surgery admitted from December 2023 to May 2024 were randomly divided into an observation group (n=50) and a control group (n=50) by drawing lots. The control group underwent peripheral difficult vein puncture using ultrasound assisted localization technology, while the observation group underwent peripheral difficult vein puncture guided by ultrasound surgery. Compare the success rate, puncture time, puncture pain, complications, and nursing satisfaction rate of two groups of patients. There was no significant difference in the success rate of one-time puncture (84.00%) and overall success rate (98.00%) between the observation group and the control group (P>0.05); The average time for the observation group to complete the puncture was longer than that of the control group. The average pain score of the observation group patients during puncture (2.12 ± 0.36) was significantly lower than that of the control group (2.99 ± 0.46), and the difference was statistically significant (P<0.05); The incidence of complications in the observation group was 4.00%, which was significantly lower than that in the control group. The reduction in complications was statistically significant (P<0.05); The nursing satisfaction rate of the observation group was 94.00%, which was higher than that of the control group, and this increase was statistically significant (P<0.05). Conclusion : In patients undergoing orthopedic surgery, the use of ultrasound technology can significantly improve the success rate of peripheral vein puncture when facing difficulties. When using ultrasound assisted positioning technology, the time required for puncture can be shortened. When using real-time ultrasound guidance for puncture, patients experience less pain, fewer complications, and higher satisfaction with the procedure.
Key words： Orthopedic surgery; Peripheral difficult venipuncture; Real time ultrasound guidance; Ultrasound assisted localization technology; Puncture successful
参考文献 References
[1] 厉海英,冯立恒,楚艳茹,等.超声引导下短轴平面外及长轴平面内技术对肥胖患者外周静脉穿刺效果比较[J].国际护理学杂志, 2021, 40(20):3738-3741.
[2] 赵红霞.超声监测辅助心电图引导经外周静脉穿刺置入中心静脉导管头端定位的价值[J].实用临床医药杂志, 2019, 23(7):37-39,43.
[3] 吴赤、彭哲哲、白洁.改良超声引导动态针尖定位技术与解剖标志定位用于婴幼儿颈内静脉穿刺的比较[J].医学综述, 2020, 26(24):4968-4962.
[4] Mcquivey K S, Chung A S, Jones M R, et al. Hospital outcomes in pediatric patients with Prader-Willi syndrome (PWS) undergoing orthopedic surgery: A 12-year analysis of national trends in surgical management and inpatient hospital outcomes[J]. Journal of orthopaedic science, 2022,27(6): 1304-1308.
[5] 任俊屹,王楠,周游,等.超声引导下疑难上肢外周浅静脉穿刺的临床应用效果[J].海南医学, 2021, 32(8):1024-1026.
[6] 亢忠杰,张志飞.不同超声辅助方法颈内静脉穿刺置管在急危重症患者中的应用[J].新疆医学, 2018, 48(5):510-512.
[7] 刘文杰,高民,张留平,等.基于超声的血管穿刺定位技术在血液透析疑难动静脉内瘘患者中的应用[J].现代医学, 2023, 51(2):170-174.
[8] 黎剑霞,张园园,曹晶.经床旁彩超引导定位在肿瘤患者经外周静脉穿刺中心静脉置管中的应用效果[J].中国当代医药, 2022,29(6):32-34.
[9] Jun H , Hideyuki T , Masanori N ,et al.Risk factors for postoperative complications of orthopedic surgery in patients with hemophilia: Second report[J].Journal of Orthopaedics, 2018, 15(2):558-562.
[10] 曹海洋,贺海丽,曹梦如.超声隔离定位技术在手术室困难外周静脉穿刺中的应用[J].北京医学, 2020, 42(1):82-84.