【摘要】 目的观察不同角度的头低位对右颈内静脉穿刺置管的影响,确定最优的头低位角度,为改进颈内静脉穿刺置管术提供依据。方法采用120例围术期需行颈内静脉穿刺置管患者,男女不限,年龄18-70岁,ASAⅠ-Ⅲ级,BMI>18kg/m~2且BMI<25kg/m~2。排除标准:中心静脉穿刺史,难以控制的高血压,心脏病心包膜疾病史、慢性阻塞性肺疾病、颈椎病或者颈部外伤史。将病人随机分4组,在麻醉诱导行气管插管后采取仰卧水平位,头分别左旋0°、15°、30°,将超声探头置于环状软骨水平,测量右侧颈内静脉的直径。在获得颈内静脉直径最大的头旋转角度后,调整手术床,分别在头低位角度0°、10°、20°、30°下测出右颈内静脉横径和横截面积(监测病人三个呼吸周期,取最大值),在解剖定位下行右颈内静脉穿刺置管。记录超声测得不同角度头低位的最大颈内静脉横径、横截面积、穿刺成功率及并发症发生情况。结果在头左旋15°、头低位30°的体位下右颈内静脉直径最大(1.56±0.14)cm、静脉横截面积最大(2.05±0.31)cm~2并且穿刺成功率最高(97.5%)。结论在头左旋15°、头低位30°的体位下进行右颈内静脉穿刺具有成功率高的特点,值得临床推广应用。更多还原

【Abstract】 Objective To observe the effect of head-down position with different angle on right internal jugular venous cathetering for determinimg the best angle and providing the basis for ameliorating internal jugular venous cathetering.Methods On perioperative period,120 cases of internal jugular venous cathetering,male of female,age 18~70,ASAⅠ~Ⅲ,BMI>18kg/m2 and BMI<25kg/m2.Exclusion criteria:history of internal jugular venous cathetering,uncontrollability hypertension,history of pericardium disease,chronic obstructive pulmonary disease,cervical spondylosis,and history of neck trauma.The patients were divided randomly into 4 groups.After anesthesia induction and tracheal intubation,the patients lay supine horizontal position,and head lay sinistrogyration 0°、15°、30°.The ultrasonic probe was put in the level of cricoid cartilage and the diameter of right internal jugular venous was measured.After getting the head rotation angle with the biggest diameter of right internal jugular venous,the operation table was adjusted.The diameter of right internal jugular venous and the cross sectional areas were measured at the head-down position angle of 0°、10°、20°、30°(mornitoring 3 respiratory cycle,take the max value).The right internal jugular venous cathetering was performed at anatomical localization.The biggest diameter of right internal jugular venous and the cross sectional areas determined by ultrasound,the success rate and the complication were recorded.Results The biggest diameter of right internal jugular venous(1.56±0.14) and the biggest cross sectional areas(2.05±0.31) and the highest success rate of puncture(96.67%) at the position of head sinistrogyration 15°and the head-down position angle of 30°.Conclusion It has the high success rate that right internal jugular venous cathetering was performed at the position of head sinistrogyration 15° and the head-down position angle of30°.It is worth for popularization and application.更多还原