| 摘要: |
| 目的研究喉罩对右侧颈部血管相对和绝对位置以及对颈内静脉穿刺成功率的影响。方法 86例择期行单侧全膝关节置换术患者,根据气道控制方式不同随机分为喉罩组(LMA)和气管插管组(EI),LMA组44例,EI组42例。分别于喉罩或气管导管置入前后用超声测量右侧中位(胸锁乳突肌的胸骨头与锁骨头的交叉顶点)颈内静脉(internal jugular vein, IJV)和颈总动脉(common carotid artery, CCA)直径、动静脉重叠距离,计算动静脉重叠率；测量中位的体表标记点移位距离,血管中心体表投射至颈部正中线距离。根据解剖定位法行IJV穿刺,比较两组一针成功率、失败率、误穿动脉率。结果喉罩置入后,体表标记点明显向头外侧移位(6.3±2.1)mm。IJV直径无变化,CCA直径变小,动静脉重叠率显著增加,CCA、IJV中心体表投射至正中线距离均增加(P＜0.05)。LMA组一针成功率显著低于EI组(分别为81.8%、97.7%),差异有统计学意义(P＜0.05)。LMA组、EI组误穿动脉分别为6例、1例,差异有统计学意义(P＜0.05)。结论 喉罩置入后,IJV、CCA、体表标记点均向外侧移位,动静脉相对和绝对距离发生变化,依靠解剖定位颈内静脉穿刺难度增加,增加了超声引导穿刺的几率。 |
| 关键词: 喉罩 颈内静脉 颈总动脉 颈内静脉穿刺 |
| DOI：10.16118/j.1008-0392.2015.02.020 |
| 投稿时间：2014-09-09 |
| 基金项目: |
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| Effects of laryngeal mask on position of right neck vesselsand success rate of jugular vein puncture |
| WANG Fen,ZHOU Ying-jie |
| (Dept. of Anesthesiology, Tenth People's Hospital, Tongji University, Shanghai 200072, China) |
| Abstract: |
| Objective To study the effects of laryngeal mask on the position of the right neck vessels and the success rate of jugular vein puncture. MethodsEighty six patients undergoing elective unilateral total knee arthroplasty were randomly divided into laryngeal mask group (LMA, n=44) and endotracheal intubation group (EI, n=42). The diameter of internal jugular vein (IJV), common carotid artery (CCA) at the cross vertex point between sternum and clavicular end of sternocleidomastoid, and arteriovenous overlap distance around the laryngeal mask or endotracheal tube placement were measured with ultrasonography. The overlap rate of arteriovenous was calculated. The shift distance of surface markers and the distance between vascular center surface projection and the midline of the neck were also measured. According to the anatomical location, the puncture of IJV was performed and the one puncture success rate, failure rate and the incidence of puncturing into artery were compared between two groups. ResultsAfter laryngeal mask insertion, surface markers shifted (6.3±2.1)mm to the lateral head. The diameter of IJV unchanged, but that of CCA became smaller and arteriovenous overlap rate increased significantly. There was significant difference in the distance between vascular center surface projection and the midline of the neck. One puncture success rate of LMA group was significantly lower than that of EI group (81.8% vs 97.7%, P＜0.05). The incidence of puncturing into artery in LMA group were more than that in EI group (6 vs 1, P＜0.05). ConclusionAfter laryngeal mask insertion, IJV, CCA and surface markers are shifted, the relative and absolute distance of arteries and veins changed, which increases the difficulty of internal jugular vein puncture according to surface markers and needs of ultrasound-guided puncture. |
| Key words: laryngeal mask internal jugular vein carotid artery internal jugular vein puncture |
