目的 研究喉罩置入对颈内静脉与颈总动脉解剖关系的影响, 寻找喉罩全身麻醉下, 颈内静脉穿刺适合的入路, 提高穿刺成功率。方法 选择喉罩全身麻醉择期手术患者30例, 应用超声波扫描术, 在胸锁乳突肌三角顶点和锁骨上窝2 cm位置, 头部偏转0°、30°、60°和最大角度, 在喉罩置入前后分别测定双侧颈内静脉与颈总动脉的夹角和动脉重叠率。结果 胸锁乳突肌三角顶点和锁骨上窝2 cm位置, 随患者转头角度的增加, 双侧颈内静脉与颈总动脉的夹角逐渐减小(P<0.05), 动脉重叠率逐渐增高(P<0.05)。胸锁乳突肌三角顶点位置, 喉罩置入后, 与相同转头角度喉罩置入前比较, 动静脉夹角明显减小(P<0.05), 而动脉重叠率明显增高(P<0.05)。锁骨上窝2 cm位置, 喉罩置入对动静脉夹角和动脉重叠率均无明显影响(P>0.05)。结论 转头与喉罩置入充气可改变颈内静脉与颈总动脉解剖关系, 增加穿刺难度, 了解这一变化规律有助于选择适宜的穿刺路径, 降低颈内静脉穿刺时误伤颈总动脉的发生率。
Abstract
Objective To demonstrate the effects of laryngeal mask airway (LMA) placement on anatomic relationship of the internal jugular vein (IJV) with the common carotid artery (CCA) in order to find the optimal approach and avoid inadvertent puncture of the CCA during central venous access. Methods Thirty elective surgical patients requiring LMA general anesthesia were included. The relationship between the IJV and the CCA at two points (the apex of the triangle formed by the sternocleidomastoid muscle and 2 cm above supraclavicular fossa) at 0°, 30°, 60° and maximum head rotation were analyzed by ultrasonography. Results With the increased head rotation, the angle between IJV and CCA became smaller (P<0.05) and the percent overlap of CCA and IJV gradually increased at both sides (P<0.05). At the apex of the sternocleidomastoid triangle, the angle between IJV and CCA decreased and the percent overlap of CCA increased after LMA insertion (P<0.05). There were no statistical differences before and after LMA insertion at the point of 2 cm above supraclavicular fossa at any degree of head rotations (P>0.05). Conclusions Head rotation and LMA placement alter the relationship between the IJV and the CCA. Knowledge of the variation tendency of IJV and CCA anatomy is important information for the operator performing an IJV puncture, to potentially reduce the chance of laceration of the CCA.
关键词
喉罩 /
中心静脉穿刺 /
颈内静脉 /
颈总动脉 /
超声波扫描术
Key words
laryngeal mask airway /
central venous access /
internal jugular vein /
common carotid artery /
ultrasonography
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参考文献
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