呼吸末正压通气对全身麻醉婴幼儿颈内静脉横截面积及穿刺的影响  

The effects of positive end expiratory pressure on the cross-sectional area and puncture of internal jugular vein in infants with general anesthesia

作　　者：王喜军 邹春云 韦松里 陆思施 黎斌 Wang Xijun;Zou Chunyun;Wei Songli;Lu Sishi;Li Bin(Anesthesiology Department,Guangxi International Zhuang Medical Hospital of Guangxi University of Chinese Medicine,Nanning 530201,China)

机构地区：[1]广西中医药大学附属国际壮医医院麻醉科,南宁530201

出　　处：《广西医科大学学报》2021年第6期1196-1200,共5页Journal of Guangxi Medical University

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题资助项目(No.Z20191055)。

摘　　要：目的:探讨呼吸末正压通气(PEEP)对全身麻醉婴幼儿颈内静脉横截面积及穿刺的影响。方法:将选取2018年9月至2020年9月广西中医药大学附属国际壮医医院年龄在1个月至3岁全身麻醉婴幼儿60例,根据对小儿深静脉穿刺时使用的PEEP值不同分为4组,P0组(0 kPa)、P3组(0.294 kPa)、P6组(0.588 kPa)、P9组(0.882 kPa),每组15例;患者全麻诱导后行气管插管并行机械通气,由同一个麻醉医生对患者在固定位置获取右侧颈部超声图像并穿刺置管。记录右侧颈内静脉CSA、前后径和横径,颈总动脉直径,颈总动脉重叠长度,穿刺置管成功率,并发症发生情况,对各组观察指标进行比较,评估穿刺效果。结果:在颈内静脉横截面积、前后径、横径中,P9组明显高于P6组,P6组明显高于P3组、P0组(P<0.05);在动―静脉重叠长度中,P9组明显长于P0组、P3组、P6组(P<0.05);在安全穿刺范围中,P9组明显小于P0组、P3组、P6组(P<0.05);P6组穿刺成功率明显高于P0组、P3组、P9组(P<0.05);P9组误穿动脉高于P3组、P6组,血肿发生率均高于P0组、P3组、P6组(P<0.05)。结论:应用PEEP能够有效增加全身麻醉婴幼儿颈内静脉横截面积,但动—静脉重叠长度也相应增加;婴幼儿颈静脉穿刺中,在B超引导下应用PEEP 0.588 kPa能有效提高穿刺成功率,并减少并发症发生率。Objective: To investigate the effects of positive end expiratory pressure(PEEP) on the cross-sectional area and puncture of internal jugular vein in infants with general anesthesia. Methods: From September 2018 to September 2020, 60 infants aged from one month to three years under general anesthesia in our hospital were selected. The children were divided into four groups according to the PEEP value used in deep vein puncture: P0 group(0 kPa), P3 group(0.294 kPa), P6 group(0.588 kPa) and P9 group(0.882 kPa), with 15 cases in eachgroup.After induction of general anesthesia, the infants underwent tracheal intubation and mechanical ventilation, and the same anesthesiologist obtained the ultrasound image of the right neck at a fixed position and inserted the catheter.CSA, anteroposterior diameter and transverse diameter of right internal jugular vein, diameter of common carotid artery, overlapping length of common carotid artery, success rate of puncture and catheterization, puncture time and complications were recorded. The observation indexes of each group were compared to evaluate the puncture effect.Results: Cross-sectional area, anteroposterior diameter and transverse diameter of internal jugular vein in P9 group were significantly higher than those in P6 group, and these indexes were higher in P6 group than those in P3 group and P0 group(P<0.05). The length of arteriovenous overlap in P9 group was significantly higher than that in P0, P3 and P6 groups(P<0.05).The safe puncture range in P9 group was significantly lower than that in P0, P3 and P6 groups(P<0.05). The success rate of puncture in P6 group was significantly higher than that in P0, P3 and P9 groups(P<0.05). The incidence of artery puncture in P9 group was higher than that in P3 and P6 groups, and the incidence of hematoma in P9 group was higher than thatin P0, P3 and P6 groups(P<0.05). Conclusion: PEEP can effectively increase the cross-sectional area of internal jugular vein in infants under general anesthesia, but the length of arteriovenous overlap

关 键 词：呼吸末正压通气 全身麻醉 婴幼儿 颈内静脉 

分 类 号：R614[医药卫生—麻醉学]