超声引导对明确新生儿不同体位下股动静脉解剖关系及其穿刺的指导意义  

Ultrasonic guidance on the anatomical relationship between femoral artery and venous and on puncture in different position of newborns

作　　者：王蕾[1] 曾晓莉[1] 房先杰 罗小玲[1] WANG Lei, ZENG Xiao-li, FANG Xian-jie, LUO Xiao-ling(Department of Anesthesiology, Shiyan Maternal and Child Health-Care Hospital, Shiyan, Hubei 442000, China)

机构地区：[1]十堰市妇幼保健院麻醉科,湖北十堰442000

出　　处：《中国临床研究》2018年第9期1274-1277,共4页Chinese Journal of Clinical Research

基　　金：十堰市科学技术研究与开发项目(16Y84)

摘　　要：目的探讨超声引导对明确新生儿不同体位下股动静脉解剖关系及其对穿刺的指导意义。方法选取2012年9月至2017年8月间进行择期腹部手术的54例新生儿作为研究对象,根据穿刺体位的不同分为观察组30例与对照组24例,所有新生儿都给予超声引导下中心静脉穿刺置管术(CVC),记录股静脉的位置、重叠情况与相关参数。结果股静脉均主要位于股动脉的内下方(29例,53. 7%),其次位于内侧(16例,29. 6%),少数位于外下方(3例,5. 6%),极少数位于外侧(2例,3. 7%)及内上方(1例,1. 9%)。所有患儿从腹股沟韧带处至下方4 cm处股动脉与股静脉夹角均逐渐增大、股静脉深度逐渐增加、未重叠宽度逐步减小(P <0. 05),观察组与对照组对比也有统计学差异(P <0. 05)。所有新生儿腹股沟韧带下2 cm的股动静脉重叠率都高于腹股沟韧带边缘(P <0. 05),且观察组腹股沟韧带边缘、腹股沟韧带下方2 cm股动静脉重叠率低于对照组(P <0. 05)。结论超声引导下CVC能明确新生儿不同体位下股动静脉解剖关系,下肢外展体位时可减小股静脉深度与重叠率,也可增加股静脉未重叠宽度,有很好的应用价值。Objective To explore the significance of ultrasound guidance on clarifying the anatomical relationship between femoral artery and vein and on guiding for puncture in different postures of newborns. Methods Fifty-four newborns with elective abdominal surgery from September 2012 to August 2017 were selected as study objects and divided into observation group（n = 30） and control group（n = 24） according to different puncture position. The ultrasound-guided central venous catheterization（CVC） was performed in all cases to record the location,overlap and related parameters of femoral vein（FV）. Results The femoral veins mainly located in the inferior part of femoral artery（29 cases,53. 7%）,followed in medial（16 cases,29. 6%）,and a few in the outer inferior part（3 cases,5. 6%）,and fewer in the lateral（2 cases,3. 7%） and in the upper part（1 case,1. 9%）. The angle between femoral artery and femoral vein increased gradually at4 cm below inguinal ligament with gradually increasing femoral vein depth and decreasing non-overlapped width. There was a statistical difference between two groups（P〈0. 05）. In all neonates,the femoral arteriovenous overlap of 2 cm under inguinal ligament was higher than that in the edge of inguinal ligament（P〈0. 05）,and the rates of femoral arteriovenous overlap in the 2 cm under inguinal ligament and the edge of inguinal ligament were lower in observation group than those in control group（P〈0. 05）. Conclusion Ultrasound-guided CVC can confirm the anatomic relationship of femoral artery and femoral vein in different postures of newborn and can reduce the depth and overlap of femoral vein and increase the unoverlapping width of femoral vein in abduction position of the lower extremities. It has a good application value.

关 键 词：超声 中心静脉穿刺置管术 新生儿 解剖关系 股动静脉 重叠率 

分 类 号：R472[医药卫生—护理学]