不同颈部平面下患儿右颈内静脉穿刺相关椎动脉损伤的解剖因素及风险评估  

Anatomical factor and risk assessment of right internal jugular vein puncture-related damage to vertebral artery at different neck planes in pediatric patients

作　　者：袁开明[1] 王勤赛 刘恩慈 上官王宁[1] 连庆泉[1] 李军[1] Yuan Kaiming, Wang Qinsai, Liu Enci, Shangguan Wangning, Lian Qingquan, Li Jun(Department of Anesthesiology and Perioperative Medicine, Second Affiliated Hospital of Wenzhou Medical University and Yuying Children＇s Hospital, Wenzhou 325027, China)

机构地区：[1]温州医科大学附属第二医院育英儿童医院麻醉与围术期医学科,325027

出　　处：《中华麻醉学杂志》2018年第4期395-398,共4页Chinese Journal of Anesthesiology

基　　金：温州市公益性科技计划项目（Y20150231）

摘　　要：目的 评价不同颈部平面下患儿右颈内静脉穿刺相关椎动脉损伤的解剖因素及风险评估.方法 择期手术患儿210例,性别不限,年龄6个月～10岁,BMI＜28 kg/m^2,分别在环状软骨平面、锁骨上平面以及中间平面,用超声检查右侧颈内静脉和椎动脉,记录椎动脉与颈内静脉的相对位置、颈内静脉和椎动脉直径.（计算椎动脉与颈内静脉直径比值）、颈内静脉与椎动脉重叠状态、颈内静脉与椎动脉的水平和垂直距离;计算椎动脉损伤的风险系数.结果 97％患儿椎动脉位于右颈内静脉外侧深部.3个颈部平面间椎动脉与颈内静脉相对位置关系各指标比较差异无统计学意义（P＞0.05）.随颈部平面降低,椎动脉与颈内静脉直径比值降低,椎动脉与颈内静脉垂直距离和水平距离均缩短,重叠率升高,椎动脉损伤的风险系数升高（P＜0.05或0.01）.3个颈部平面椎动脉与颈内静脉垂直距离与患儿年龄、体重和身高无相关性（P＞0.05）.在环状软骨平面和中间平面,椎动脉损伤的风险系数与患儿年龄、身高和体重无相关性（P＞0.05）;在锁骨上平面,椎动脉损伤的风险系数与患儿体重呈正相关（P＜0.05,r=0.215）.结论 随着颈部平面降低,患儿右侧椎动脉与颈内静脉逐渐靠近;颈部穿刺平面越低,患儿椎动脉损伤的风险逐渐增加.Objective To evaluate the anatomical factor and risk assessment of right internal jugular vein （IJV） puncture-related damage to the vertebral artery （VA） at different neck planes in pediatric patients.Methods Two hundred and ten pediatric patients of both sexes,aged 6 months-10 yr,with body mass index less than 28 kg/m^2,undergoing elective surgery,were enrolled in this study.At the cricoid cartilage plane,supraclavicular area plane and intermediate plane,the right IJVs and VAs were examined using ultrasound.The VA position relative to the IJV,diameters of IJVs and VAs （the diameter ratio of VAs to IJVs was calculated）,extent of overlap between IJVs and VAs,and horizontal and vertical distance from VAs to IJVs were recorded,and the risk coefficient of accidental VA puncture was calculated.Results Ninety-seven percent of VAs lay deep and lateral to right IJVs.There was no significant difference in each parameter of VA position relative to IJVs between the three planes （P〉0.05）.The diameter ratio of VAs to IJVs was decreased with the decreasing neck plane,the horizontal and vertical distance from VAs to IJVs was significantly shortened,the overlapping rate between VAs and IJVs was increased,and the risk coefficient of accidental VA puncture was increased （P〈0.05 or 0.01）.The vertical distance from VAs to IJVs was not correlated with age,body weight or height （P〉0.05）.The risk coefficient of VA damage was not correlated with age,body weight or height at the cricoid cartilage plane and intermediate plane （P 〉 0.05）.The risk coefficient of VA damage was positively correlated with the weight of pediatric patients at the supraclavicular area plane （P〈0.05,r=0.215）.Conclusion Right VAs come nearer IJVs with the decreasing neck plane;the risk of VA damage increases gradually with the lowering of neck planes in pediatric patients.

关 键 词：椎动脉 颈静脉 静脉切开术 儿童 

分 类 号：R726.1[医药卫生—儿科]