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研究生: 黃冠傑
Huang, Guan-Jie
論文名稱: 超音波輔助內頸靜脈注射導引之設計與評估
Design and Evaluation of Ultrasound Needle Guide for Internal Jugular Venous Cannulation
指導教授: 張志涵
Zhang, Zhi-Han
學位類別: 碩士
Master
系所名稱: 工學院 - 生物醫學工程學系
Department of BioMedical Engineering
論文出版年: 2014
畢業學年度: 102
語文別: 中文
論文頁數: 43
中文關鍵詞: 內頸靜脈導管引導注射超音波
外文關鍵詞: Internal jugular venous catheters, Needle guide, Ultrasound
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  • 中央靜脈導管放置是臨床上常用的醫療步驟,主要是為了要獲得靜脈通道。常見的併發症有動脈刺穿、血胸、氣胸,其中又以動脈刺穿的機率最高。
    之前文獻有統計全美有9.4%的人,靜脈與動脈的位置有解剖上的差異,因此近年來開始使用超音波輔助內頸靜脈注射引導(needle guide ultrasound),使用了超音波輔助後,可以有效的提高注射的成功率,但仍然無法降低總頸動脈穿刺的機率,文獻中猜測可能是因為無法去控制針頭的深度。
    因此本研究製作新型超音波輔助注射導引裝置,可以用來控制針頭的深度,希望可以提高注射的成功率,並且降低動脈的穿刺的機率,透過3D 列印製作模具並搭配洋菜膠、碳粉與橡膠管,去建立出頸部假體。
    本研究找了八個操作者,其中六個是沒有任何臨床扎針經驗的操作者,一個是沒有使用過超音波臨床醫生,一個是有超音波經驗的臨床醫生,隨機的使用超音波與超音波注射引導的方法,透過自製的假體去評估注射的時間、成功率以及動脈刺穿的機率。
    結果發現在沒有臨床扎針經驗的操作者,使用注射引導可以有效的提高30%成功率以及降低23.3%動脈刺穿的機率,在沒有超音波經驗的臨床醫生身上,使用注射引導可以有效的提高40%成功率,在有超音波經驗的臨床醫生上,兩者方法均沒有差別,平均而言使用注射引導所花費的時間較傳統的超音波來的長大約20秒。

    Central venous catheters (CVCs) are commonly used in clinical procedure to gain venous access. Common complications of using CVCs include arterial puncture, which is the most frequent, hemothorax and pneumothorax. In a previous study, 9.4% people in the United States were reported to have anatomical variations. Ultrasound needle guides are being increasingly used to improve the success rate of internal jugular vein (IJV) cannulation. However, the rate of carotid artery puncture is not reduced because the depth of the needle cannot be controlled even with the ultrasound. Therefore, a new type of needle guide is proposed in this study. The developed needle guide can be used to limit the depth of acupuncture treatment, thus improving the success rate of injection and reducing the possibility of carotid artery puncture. Further, a mold is fabricated using (three-dimensional) 3D printing, and agar, carbon dust, and a rubber tube are used to build a neck phantom. In this study, eight operators randomly used the conventional ultrasound and proposed needle guides to puncture the phantom and recorded the procedure time, success rate, and arterial puncture rate. The results showed that when a needle guide was used, a success rate of 40% was achieved and the artery injury rate was reduced to 11% but with a longer procedure time.

    中文摘要 I SUMMARY II 致謝 IX 目錄 X 表目錄 XII 圖目錄 XIII 第一章 前言 1 1.1中央靜脈導管 1 1.1.1中央靜脈導管種類 1 1.2 內頸靜脈解剖構造 2 1.3中央靜脈導管放置 4 1.3.1 Landmark 方法 5 1.3.2超音波方法 6 1.3.3Modified seldinger 技術 9 1.3.4併發症 10 1.4研究動機 11 第二章材料與方法 12 2.1研究流程 12 2.2超音波引導注射裝置 13 2.2.1建立超音波模型 14 2.2.2超音波引導注射裝置 15 2.3內頸靜脈假體 20 2.3.1內頸靜脈模型 20 2.3.2模具設計 22 2.3.3模具製作 25 2.4實驗設計 27 第三章結果與討論 29 3.1注射導引裝置 29 3.2自製假體 31 3.2.1假體影像 32 3.3實驗數據 33 第四章總結 41 第五章參考文獻 42

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