文章摘要
婴幼儿右颈内静脉特征及其与颈部大动脉的毗邻关系
Characteristics of right internal jugular vein and its adjacent relationship with great cervical arteries in infants
  
DOI:10.12089/jca.2020.12.001
中文关键词: 中心静脉穿刺  颈总动脉  椎动脉  超声
英文关键词: Central venous catheterization  Common carotid artery  Vertebral artery  Ultrasound
基金项目:重大新药创制国家科技重大专项(2020ZX09201002)
作者单位E-mail
王勤赛 325027,温州医科大学附属第二医院,育英儿童医院麻醉与围术期医学科  
徐超锋 325027,温州医科大学附属第二医院,育英儿童医院麻醉与围术期医学科  
洪阿梅 325027,温州医科大学附属第二医院,育英儿童医院麻醉与围术期医学科  
翟子昕 325027,温州医科大学附属第二医院,育英儿童医院麻醉与围术期医学科  
李军 325027,温州医科大学附属第二医院,育英儿童医院麻醉与围术期医学科  
袁开明 325027,温州医科大学附属第二医院,育英儿童医院麻醉与围术期医学科 yuankm_wh@163.com 
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中文摘要:
      
目的 采用超声观察婴幼儿颈部不同平面右侧颈内静脉横径大小并分析相关因素,观察其与颈部大动脉之间的毗邻关系。
方法 选择择期手术的患儿90例,年龄6个月至3岁,ASA Ⅰ或Ⅱ级,在全麻诱导置入合适喉罩后使用七氟醚维持麻醉深度,并保留自主呼吸。患儿均为平卧位,头转向左侧约40°。使用超声分别在环状软骨平面、锁骨上平面及两个平面之间的中间平面观察右侧颈内静脉、颈总动脉和椎动脉的短轴成像,分别在三个平面测量颈内静脉、颈总动脉和椎动脉的血管横径;记录颈总动脉或椎动脉与颈内静脉之间相对方位;观察颈总动脉与颈内静脉、椎动脉与颈内静脉之间是否重叠,如有重叠则测量重叠程度;测量椎动脉(前壁)与颈内静脉(后壁)间的垂直深度。
结果 颈内静脉横径在中间平面、锁骨上平面均明显大于环状软骨平面(P<0.05)。在三个平面中,颈内静脉横径大小均与患儿月龄呈正相关,其位置均位于颈总动脉前方。相对于颈内静脉,颈总动脉随着平面的下移而越来越靠近内侧(P<0.05)。颈内静脉与颈总动脉重叠程度在锁骨上平面明显低于其他平面(P<0.05)。颈内静脉与椎动脉重叠程度在锁骨上平面明显大于环状软骨平面(P<0.05)。椎动脉均位于颈内静脉深部,两者间在锁骨上平面的垂直深度最浅(P<0.05)。
结论 在不同颈部水平,婴幼儿右颈内静脉与颈部大动脉的相对位置不同。在右颈内静脉高位穿刺应更加警惕颈总动脉损伤的风险,而在低位需警惕椎动脉损伤的风险,同时避免使用穿透颈内静脉后壁法。
英文摘要:
      
Objective To observe the transverse diameter of right internal jugular vein at different levels of infant neck and its determinants, and to describe the adjacent relationship between right internal jugular vein and great cervical arteries.
Methods Ninety infants undergoing elective surgery, aged 6 months to 3 years, ASA physical status Ⅰ or Ⅱ, were enrolled in this study. Followed by insertion of an appropriate LMA after induction, general anesthesia was maintained with sevoflurane and spontaneous breathing was kept. All the infants were placed in a supine position and their heads were rotated 40 degrees to the left. The right internal jugular vein, common carotid, and vertebral arteries were explored under ultrasound (in short axis) at the cricoid cartilage level, the supraclavicular level, and the middle of the two levels. The transverse diameters of above vessels were measured. Locations of common carotid and vertebral arteries relative to the internal jugular vein were recorded. The overlap of internal jugular vein and the common carotid artery or vertebral artery was observed. If they were overlapped, overlapping widths (percents) of common carotid artery-internal jugular vein or vertebral artery-internal jugular vein were measured. The vertical depth between the vertebral artery (anterior wall) and the internal jugular vein (posterior wall) was measured.
Results The transverse diameter of internal jugular vein at the cricoid cartilage level and the supraclavicular level was significantly larger than that at the middle level (P < 0.05). At the three levels, internal jugular vein located anteriorly to the common carotid artery, and its diameter was positively correlated with infant age. Relative to the internal jugular vein, the common carotid artery moved to the medial side along with the level descending (P < 0.05). The overlapping degree of the internal jugular vein and the common carotid artery was the lowest at the supraclavicular level (P < 0.05). Compared with cricoid cartilage level, the overlapping degree of internal jugular vein and vertebral artery in supraclavicular level was greater (P < 0.05). Vertebral artery was also deeper relative to internal jugular vein, and the vertical depth at the supraclavicular level was smaller compared with the cricoid cartilage level (P < 0.05).
Conclusion At different neck levels, the relative positions of right internal jugular vein and great arteries are different. When performing right internal jugular vein catheterization at high neck level, accidental puncture of the common carotid artery should be on the alert, while accidental puncture of the vertebral artery should be matched out for at low neck level, and penetrating the posterior wall of the internal jugular vein should be avoided.
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