不同头位下超声与体表解剖定位在颈内静脉穿刺中的比较  

A comparison of ultrasound guided and anatomical localization with different head position in the internal jugular vein puncture

作　　者：张明[1] 赵国胜[1] 韩斌[1] 徐铭军[1] 

机构地区：[1]首都医科大学附属北京妇产医院麻醉科,100026

出　　处：《北京医学》2014年第11期933-935,共3页Beijing Medical Journal

摘　　要：目的比较B超引导与体表标志定位在颈内静脉穿刺术患者确定具体穿刺点和进针方向上的区别,并探讨患者的最佳头位。方法选择患者100例,取头部正中位、左偏30°和左偏最大角度,分别测量颈内静脉直径、颈总动脉直径、颈内静脉覆盖颈总动脉的宽度(动静脉重叠率)及颈总动脉中点与颈内静脉中点的距离(动静脉中点距离)。同时分别依据体表标志和超声定位确定颈内静脉穿刺的穿刺点和进针方向。比较两种定位方法确定穿刺点之间的距离和进针方向之间的角度。结果不同头位时颈内静脉直径无明显变化(P>0.05)。头部正中位与头部左偏30°比较,颈总动脉直径无明显变化(P>0.05),动静脉重叠率增加(P<0.05),动静脉中点距离减小(P<0.05)。头部左偏最大角度与头部正中位及头部左偏30°比较,颈总动脉直径明显变小(P<0.01),动静脉重叠率明显增加(P<0.01),动静脉中点距离明显减小(P<0.01)。超声定位法与体表标志定位法相比,两者穿刺点之间的距离为(9.7±5.8)mm,两者穿刺方向之间的角度为(25.9±10.7)°。结论解剖标志定位法与超声定位法在穿刺点和穿刺方向均存在较大差别。在无超声定位引导条件下,如果多次穿刺未成功应该考虑将穿刺点外移1 cm左右甚至更多,且穿刺方向指向锁骨上切迹。其次,随着头位左偏角度的逐渐增大,误穿动脉的风险逐渐增高,应该尽量减少左偏角度完成操作。Objective To compare the ultrasound guided puncture and anatomical localization puncture of the internal jugular vein, and to access the best head position for the puncture. Methods One hundred patients undergoing gynecological operation were enrolled into this study. The diameter of internal jugular vein and carotid artery, the interval of the midpoint between the internal jugular vein and carotid artery were recorded. The rate of artery-vein overlap was calculated. The two methods with the point of puncture and the angle of the puncture were compared. Results Along with the angle of the head was adding, the diameter of internal jugular was no significantly changed, but the diameter of carotid artery was diminished, the interval of the midpoint between the artery and vein was significantly diminished, the rate of artery-vein overlap was significantly increased. Compare the two puncture methods, the interval of the point of puncture was （9.7±5.8）mm, and the angle of the puncture was （25.9±10.7）°. Conclusion The point of puncture and the angle of the puncture of the two methods with are significantly different. This suggests that if the point of puncture move toward outside for 1 cm and more, the direction of puncture is more directly towards the clavicular notch, so the risk of passing through the artery is increased. Therefore, the angle of puncture should not diverge to left during the puncture.

关 键 词：超声引导 解剖定位 颈内静脉 

分 类 号：R614[医药卫生—麻醉学]