颈外静脉单人二次加压穿刺技术在休克患者急诊手术中的应用研究

doi:10.3761/j.issn.2096-7446.2025.11.020

摘要/Abstract

摘要：

目的探讨颈外静脉单人二次加压穿刺技术在休克患者急诊手术中的应用效果。方法选择2023年1月—2024年12月进行颈外静脉穿刺的休克急诊手术患者116例为研究对象，按随机数字表法分成试验组和对照组各58例，试验组采用单人二次加压穿刺技术建立颈外静脉通路，对照组采用常规双人压迫颈外静脉盲穿法建立静脉通路，比较两组一次穿刺成功率、穿刺总成功率、穿刺静脉回血时间、穿刺成功用时、输液不畅发生率和并发症发生率的差异。结果试验组一次穿刺成功率和穿刺总成功率均明显高于对照组，差异均具有统计学意义（P<0.05）；与对照组比较，试验组穿刺静脉回血时间及穿刺成功用时明显缩短，输液不畅发生率降低，差异均具有统计学意义（P<0.05）；输液相关并发症发生率试验组（1.72%）低于对照组（12.07%）。结论颈外静脉单人二次加压穿刺技术可显著提高休克患者急诊手术中颈外静脉通路建立的一次穿刺成功率和总成功率，缩短穿刺静脉回血时间及穿刺成功用时，降低输液不畅及并发症的发生率，提升急救护理效率和质量。

关键词: 直型留置针, 颈外静脉, 休克, 急救, 手术室

Abstract:

Objective To explore the application effect of single-person secondary compression puncture technique of external jugular vein in emergency surgery for patients with shock. Methods A total of 116 patients undergoing shock emergency surgery with external jugular vein puncture between January 2023 and December 2024 were selected as study participants. They were randomly assigned to an experimental group and a control group，with 58 patients in each group. The experimental group established an external jugular vein access using a single-person double-compression puncture technique，whereas the control group established venous access via conventional double-person blind compression of the external jugular vein. Comparisons were made between the two groups in terms of the first-attempt puncture success rate，overall puncture success rate，venous blood return time after puncture，time taken for successful puncture，incidence of infusion obstruction，and incidence of complications. Results The success rates of both first-attempt puncture and overall puncture in the experimental group were significantly higher than those in the control group，with statistically significant differences（P<0.05）. Compared with the control group，the experimental group exhibited a significant reduction in both the time taken for venous blood return and successful puncture，as well as a decrease in the incidence of infusion obstruction，all with statistically significant differences（P<0.05）. Furthermore，the incidence of infusion-related complications was lower in the experimental group（1.72%） than in the control group（12.07%）. Conclusion The single-person secondary compression puncture technique for external jugular vein can significantly improve the first-attempt puncture success rate and total success rate of external jugular vein access establishment in emergency surgery for shock patients，shorten the puncture vein blood return time and puncture success time，reduce the incidence of infusion obstruction and complications，and improve the efficiency and quality of emergency nursing.

Key words: Straight Indwelling Needle, External Jugular Vein, Shock, First Aid, Operating Room

吴延华, 许彬彬, 王金萍, 王逸, 雍永芳. 颈外静脉单人二次加压穿刺技术在休克患者急诊手术中的应用研究[J]. 中华急危重症护理杂志, 2025, 6(11): 1403-1408.

WU Yanhua, XU Binbin, WANG Jinping, WANG Yi, YONG Yongfang. Research on the application of external jugular vein single-person secondary compression puncture technique in emergency surgery for shock patients[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(11): 1403-1408.

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参考文献 18

[1]	王萍, 王钰炜, 王飒, 等. 超声引导下静脉血液标本采集流程在急诊创伤性休克患者中的应用研究[J]. 中华急危重症护理杂志, 2022, 3(6):497-501.
	Wang P, Wang YW, Wang S, et al. The application of ultra-sound guided venous blood specimen collection process in emergency traumatic shock patients[J]. Chin J Emerg Crit Care Nurs, 2022, 3(6):497-501.
[2]	李玲, 季静, 田伟. 急诊改良真空负压颈外静脉穿刺相关因素分析及护理对策[J]. 齐鲁护理杂志, 2024, 30(17):89-92.
	Li L, Ji J, Tian W. Analysis of related factors of emergency improved vacuum negative pressure external jugular vein puncture and nursing countermeasures[J]. J Qilu Nurs, 2024, 30(17):89-92.
[3]	蔡东妙, 王海振, 汪海松, 等. 超声引导下颈外静脉穿刺预置管在侧卧位手术紧急抢救中应用的可行性[J]. 中国医药指南, 2024, 22(25):10-13.
	Cai DM, Wang HZ, Wang HS, et al. Feasibility of ultrasonic-guided external jugular venipuncture preplacement in emerge-ncy rescue of lateral decubitus surgery[J]. Guide China Med, 2024, 22(25):10-13.
[4]	鲜艺苑, 张小露, 王志伟, 等. 改良超声辅助定位联合动态针尖法在急诊休克患者颈内静脉穿刺置管中的应用[J]. 中国中西医结合急救杂志, 2021, 28(5):566-569.
	Xian YY, Zhang XL, Wang ZW, et al. Application of improved ultrasound-assisted localization combined with dynamic needle-point method in internal jugular vein puncture and placement of catheter for emergent shock patients[J]. Chin J Integr Tradit West Med Intensive Crit Care, 2021, 28(5):566-569.
[5]	张小纯, 张秋红, 陈洁, 等. 颈外静脉穿刺在急性创伤性休克患者急诊建立静脉通道与采血中的优势[J/OL]. 中华损伤与修复杂志(电子版), 2017, 12(6):473-476.
	Zhang XC, Zhang QH, Chen J, et al. Advantages of puncture of external jugular vein in establishing venous access and blood extraction of patients with acute traumatic shock[J/OL]. Chin J Inj Repair Wound Heal(Electron Ed), 2017, 12(6):473-476.
[6]	董凡, 刘海英. 乳腺癌患者经颈外静脉留置管给药的护理观察:评《乳腺癌护理手册》[J]. 中国实验方剂学杂志, 2022, 28(9):241.
	Dong F, Liu HY. Nursing observation of breast cancer patients taking drugs through external jugular vein indwelling catheter:Comment on Breast Cancer Nursing Manual[J]. Chin J Exp Tradit Med Formulae, 2022, 28(9):241.
[7]	周杏雯, 任玉琴, 李丹凤, 等. 头低足高位联合颈外静脉体表投影点负压穿刺在休克患者中的应用[J]. 健康之友, 2020,(18):74.
	Zhou XW, Ren YQ, Li DF, et al. Application of negative pre-ssure puncture of low head and foot high combined with external jugular vein surface projection point in shock patients[J]. Our Health, 2020,(18):74.
[8]	中华人民共和国国家卫生和计划生育委员会. 静脉治疗护理技术操作规范:WS/T 433—2013[S]. 2013.
	National Health and Family Planning Commission of the People's Republic of China. Technical practice code for intra-venous therapy nursing:WS/T 433—2013[S]. 2013.
[9]	Gorski LA, Hadaway L, Hagle ME, et al. Infusion therapy stan-dards of practice,8th edition[J]. J Infus Nurs, 2021, 44(1S Suppl 1):S1-S224.
[10]	Liu W, Tu ZZ, Liu LF, et al. Combined short- and long-axis method for internal jugular vein catheterization in premature newborns:a randomized controlled trial[J]. Acta Anaesthesiol Scand, 2021, 65(3):420-427. doi: 10.1111/aas.v65.3
[11]	赵爽, 曲鑫, 郑娜, 等. 负压穿刺法在急诊血液病患者输血中的应用[J]. 护理学杂志, 2017, 32(7):40-41.
	Zhao S, Qu X, Zheng N, et al. Application of negative pres-sure venopuncture in blood transfusion for hemopathy patients visiting the emergency department[J]. J Nurs Sci, 2017, 32(7):40-41.
[12]	吴延华, 肖蕾, 徐昌霞, 等. 改良体位在达芬奇Xi机器人胃癌手术中的应用效果[J]. 中国临床研究, 2022, 35(3):436-440.
	Wu YH, Xiao L, Xu CX, et al. Application of modified posi-tion in gastric cancer surgery with da Vinci Xi robotic sys-tem[J]. Chin J Clin Res, 2022, 35(3):436-440.
[13]	冯晓东, 李雪玉, 毕婷, 等. 继发性甲状旁腺功能亢进患者术后高浓度补钙静脉通路选择的研究[J]. 护理管理杂志, 2021, 21(2):128-131.
	Feng XD, Li XY, Bi T, et al. Exploration on intravenous calcium infusion with high dose in patients with secondary hyperparathyroidism[J]. J Nurs Adm, 2021, 21(2):128-131.
[14]	陈瑞芳, 陈华敏. 颈外静脉留置针输液技术在急诊急救中的应用[J]. 基层医学论坛, 2021, 25(24):3431-3433.
	Chen RF, Chen HM. Application of external jugular vein ind-welling needle infusion technology in emergency[J]. Med Forum, 2021, 25(24):3431-3433.
[15]	于新颖, 陈增焱, 姜苗, 等. 经颈外静脉穿刺置入中心静脉导管的临床分析[J]. 中国小儿急救医学, 2022, 29(10):832-835.
	Yu XY, Chen ZY, Jiang M, et al. Clinical analysis of central venous catheter placement through external jugular vein[J]. Chin Pediatr Emerg Med, 2022, 29(10):832-835.
[16]	魏启明, 郑翔, 张红. 右颈内静脉血液透析导管错误置入胸腔2例病例报告[J]. 血管与腔内血管外科杂志, 2018, 4(2):183-185.
	Wei QM, Zheng X, Zhang H. Misplacement of hemodialysis catheter in right internal jugular vein into thoracic cavity:a report of 2 cases[J]. J Vasc Endovasc Surg, 2018, 4(2):183-185.
[17]	潘素美. 颈外静脉留置针在院前急救输液管理中的应用[J]. 中国实用医药, 2018, 13(2):173-174.
	Pan SM. Application of external jugular vein indwelling nee-dle in pre-hospital emergency infusion management[J]. China Pract Med, 2018, 13(2):173-174.
[18]	乐梦云, 邱翔, 曾小红, 等. 颈外静脉穿刺技术在急性脑卒中患者CT增强扫描中的应用[J]. 齐鲁护理杂志, 2024, 30(4):41-44.
	Le MY, Qiu X, Zeng XH, et al. Application of external jugular vein puncture technique in enhanced CT scanning of patients with acute stroke[J]. J Qilu Nurs, 2024, 30(4):41-44.