全麻下不同径路行右颈内静脉穿刺置管术的临床观察  

Observation on right vena jugularis interna catheterization via different pathway under general anesthesia

作　　者：缪小勇[1] 徐葭[1] 曹建平[1] 

机构地区：[1]解放军第455医院,上海200052

出　　处：《临床军医杂志》2013年第5期528-529,共2页Clinical Journal of Medical Officers

摘　　要：目的比较全麻状态下，经颈动脉旁前路和胸锁乳突肌三角中路行右颈内静脉穿刺置管术的成功率及不良反应。方法将300例ASAⅠ～Ⅱ级，全麻手术须作右颈内静脉穿刺置管的患者分为两组，Ⅰ组为经颈动脉旁前路穿刺置管组（n=150），Ⅱ组为经胸锁乳突肌三角中路穿刺置管组（n=150）。Ⅰ组穿刺点位于甲状软骨上缘水平，颈动脉搏动外侧胸锁乳突肌前缘，针体与皮肤成30～35。夹角，进针方向指向同侧乳头。Ⅱ组穿刺点位于胸锁乳突肌胸骨头锁骨头和锁骨围成的三角的顶点或稍下方，针体与皮肤成20—30。夹角，进针方向指向同侧乳头方向。结果Ⅰ组的穿刺置管成功率明显高于Ⅱ组（P〈0．05）。Ⅱ组的误穿动脉率明显高于Ⅰ组（P〈0．01），两组置管困难无统计学差异（P〉0．05），两组均无气胸发生。结论全麻下行右颈内静脉穿刺置管术，经颈动脉旁前路法优于胸锁乳突肌三角中路法。Objective To study the mission success rate and the untoward effect of right vena jugularis interna catheterization by means of two ways, i.e. anterior way of carotid artery side and mid way of sternocleidomastoid triangle. Methods A total of 300 patients with ASA Ⅰ or Ⅱ due to undergo surgical operation under general anesthesia were randomized into two groups. Group Ⅰ （ n = 150） was given right vena jugularis interna catheterization via anterior way of carotid artery side, and Group Ⅱ （ n = 150） was given catheterization via mid way of sternocleidomastoid triangle. The puncture spot for Group I was at the upper edge of thyroid cartilage, outboard of carotid pulsation and lip of sternocleidomastoid. The intersection angle was kept at 30 - 35 degrees between needle and skin. The inserting needle was pointed to the ipsilateral nipple. The puncture spot for Group Ⅱ was at the peak （or slightly down） of sternocleidomastoid triangle. The intersection angle was kept at 20 - 30 degrees, with the inserting needle pointed to the ipsilateral nipple. Results The mission success rate of catheterization of Group Ⅰ was apparently higher than that of Group Ⅱ （ P 〈 0.05 ）. The mis-puncture rate was apparently higher in Group Ⅱ than in Group I （ P 〈 0.01 ）. The difficulty in catheterization of the two sites was of no significant difference （ P 〉 0.05 ）. Pneumothorax occurred in neither Group Ⅰ nor Group Ⅱ. Conclusion The right vena jugularis interna catheterization via anterior way of carotid artery side under general anesthesia is superior to that via mid way of sternocleidomastoid triangle.

关 键 词：右颈内静脉 颈动脉 胸锁乳突肌 胸锁乳突肌三角 穿刺置管术 

分 类 号：R452[医药卫生—治疗学]