| 摘要: |
| 目的观察喉罩置入对颈内静脉和颈总动脉解剖位置的影响，探讨超声引导辅助对喉罩通气时颈内静脉穿刺置管的价值。方法80例喉罩通气下行颈内静脉穿刺置管的患者随机分为两组：解剖标志定位法穿刺组（A组）和超声引导穿刺组（B组）。在低位（锁骨上窝约1 cm水平）、中位（胸锁乳突肌三角顶点水平）及高位（胸锁乳突肌前缘中点，约平甲状软骨水平），观察所有患者喉罩置入前后颈内静脉直径、颈总动脉直径、二者间距离及二者重叠率的变化；比较两组患者的一针成功率、穿刺时间及误伤动脉、血肿形成、损伤神经和气胸等并发症的发生率。结果喉罩置入前后，低位颈内静脉与颈总动脉间的距离变化、部分重叠率、完全重叠率差异有统计学意义(P<0.01)；中位颈内静脉直径变化、二者间距离变化、完全重叠率差异有统计学意义(P<0.01);高位颈内静脉直径变化、二者间距离变化、完全重叠率差异有统计学意义(P<0.05或0.01)。B组一针成功率高于A组(P<0.01)；B组穿刺完成时间短于A组(P<0.01)；B组误伤动脉、血肿形成发生率均低于A组（P<0.05或0.01）。结论喉罩置入充气会导致患者颈内静脉直径及其与颈总动脉间的相对位置发生变化，尤以处于中位水平时改变最为明显，不利于颈内静脉穿刺置管；超声引导有利于提高喉罩通气时颈内静脉穿刺置管的成功率，缩短穿刺时间，降低穿刺并发症的发生率。 |
| 关键词: 喉罩通气 颈内静脉 颈总动脉 超声实时引导 穿刺 |
| DOI：10.3724/SP.J.1008.2011.0686 |
| 投稿时间：2011-01-12修订日期：2011-05-05 |
| 基金项目: |
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| Real-time ultrasound-guided technique for internal jugular vein catheterization after inserting laryngeal mask: an analysis of clinical effectiveness |
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| Abstract: |
| 【Abstract】 Objective To compare the variance of internal jugular vein and carotid artery after inserting laryngeal mask and To assess the clinical value and safety of real-time ultrasound-guided technique for internal jugular vein catheterization with laryngeal mask ventilation. Methods Eighty patients with laryngeal mask ventilation were randomly allocated to control group(n=40) and ultrasound-guided group(n=40). before inserting laryngeal mask, every patient’s diameter of vessels, horizontal distance and overlap between internal jugular vein and carotid artery at three different level (low level: 1cm above supraclavicular fossa; middle level: junction of the two heads of the sternocleidomastoid muscle; high level: middle point of anterior border of the sternocleidomastoid muscle) were measured by ultrasound machine and it was done after inserting laryngeal mask. Punctures of the internal jugular vein in control group were performed by traditional technique, whereas punctures in another group were performed under the way of real-time ultrasound-guided. Results ①after inserting laryngeal mask, low level: diameters of the internal jugular vein and the carotid artery do not change (p>0.05); carotid artery is pushed closer to internal jugular vein (0.39±0.53, p<0.05); partial overlap rate between them increases to 75% (60/80, p<0.05); complete overlap rate between them increases to 25% (20/80, p<0.01). middle level: diameter of the internal jugular vein becomes shorter (0.72±0.15, p<0.01), but that of the carotid artery does not change (p>0.05); complete overlap rate between them reach to 100% (80/80, p<0.01). high level: diameter of the internal jugular vein becomes shorter (0.88±0.10, p<0.05), and that of the carotid artery does not change (p>0.05); the distance between them become shorter (0.25±0.39, p<0.01); partial overlap rate between them is 30% (24/80, p>0.05); complete overlap rate between them reach to 70% (56/80, p<0.01). ②in ultrasound-guided group, 38 cases were succeeded at first attempt (95%, p<0.05), the time of cannulation last shorter [(3.4±1.3)min, p<0.05] and complication of puncture occurs lower(5%, p<0.05). whereas in control group, they are not the same ( 60%, 24/40; 7.2±3.1; 37.5%, 15/40) . Conclusion Diameter of the internal jugular vein, location of the carotid artery and the overlap between them have an obvious change after inserting laryngeal mask. At the same time, real-time ultrasound-guided technique for internal jugular vein catheterization is an more effective and safer method. |
| Key words: laryngeal mask ventilation internal jugular vein carotid artery real-time ultrasound-guided technique catheterization |
