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目的 通过静态评估及实时超声引导,明确在危重症患者中经腋静脉近侧段途径中心静脉置管的成功率及早期并发症,探讨影响置管成功率及晚期并发症的可能因素.方法 2016年6月-2017年2月连云港市第一人民医院重症医学科收治的需要留置中心静脉导管的患者39例,静态评估比较腋静脉近侧段、中间段及锁骨下静脉横截面积、距体表垂直距离、导管与血管横截面积比值;行实时超声引导经腋静脉近侧段途径中心静脉置管,记录穿刺次数及早期并发症等情况;按穿刺次数将患者分为一次穿刺成功、2次及以上穿刺成功2组,比较2组患者腋静脉近侧段横截面积、距体表垂直距离、导管与血管横截面积比值的差异.结果 实时超声引导经腋静脉近侧段途径中心静脉置管操作一次穿刺成功率64.1%,2次及以上穿刺成功率35.9%,总体成功率100%,早期并发症10.3%.与腋静脉近侧段比较,腋静脉中间段及锁骨下静脉血管横截面积、距体表垂直距离的差异有统计学意义(P<0.01);与导管与腋静脉近侧段血管横截面积比值比较,导管与腋静脉中间段血管横截面积比值的差异有统计学意义(P<0.01),导管与锁骨下静脉血管横截面积比值的差异无统计学意义(P=0.058).一次穿刺成功患者与2次及以上穿刺成功患者腋静脉近侧段横截面积、距体表垂直距离、导管与血管横截面积比值比较差异无统计学意义.结论 在危重症患者中行实时超声引导经腋静脉途径中心静脉置管安全可行,值得进一步推广.“,”Objective Through the static assessment and real-time ultrasound guidance,to investigate the success rate and early complications of the central venous catheterization via proximal axillary vein in the critically ill patients. Method statically assess the cross-sectional area and vertical distance from the surface of axillary vein and subclavian vein in patients with catheterization,real-time ultrasound guided percutaneous proximal axillary vein central venous catheter, record the number of puncture and complications.Results The success rate of first puncture in the central vein catheterization via axillary vein was 64.1%, the success rate of more than two times puncture 35.9%, and the overall success rate was 100%, and the early complication rate was 10.1%.The cross-sectional area of the middle segment of the axillary vein,the vertical distance from the surface,the ratio of catheter to vessel cross-sectional area to the proximal segment of the axillary vein were significantly different (P<0.01),The cross-sectional area of the subclavian vein,the vertical distance from the surface to the proximal segment of the axillary vein were significantly different(P<0.01),There was no significant difference in the ratio of catheter to vessel cross-sectional area between the subclavian vein and the proximal segment of the axillary vein (P=0.058).There was no significant difference in the cross-sectional area of the proximal segment of the axillary vein,the distance from the surface,the ratio of catheter to vessel cross-sectional area in two groups.Conclusions It is safe and feasible to use real time ultrasound guided central venous catheterization via the axillary vein in critically ill patients,which is worthy of further promotion.