严重多发伤患者颈内静脉的粗细及其影响因素

目的 了解严重多发伤患者颈内静脉粗细和影响因素，为提高颈内静脉置管成功率提供指导。方法 超声检测50例多发伤患者和27例正常人吸气末、呼气末的颈内静脉截面积，比较2组颈内静脉粗细、影响因素及优势静脉分布情况。结果 多发伤患者颈内静脉较对照组增粗，每侧有3例截面积〈0．40cm^2，优势静脉位于右、左侧分别为37例和13例，与对照组比较，差异无统计学意义。正常组颈内静脉粗细与年龄、身高、体重有关，多发伤患者则与中心静脉压、机械通气相关。结论 多发伤患者双侧颈内静脉不对称，较正常人增粗，穿刺前超声探查和穿刺时使用呼吸机吸气暂停功能有助于提高颈内静脉置管成功率。

Size of internal jugular veins and relating influential factors in patients with severe multiple trauma

Objective To explore the size of internal jugular veins(IJV)and relating influential factors in patients with severe multiple trauma so as to guide successful catheterization of central veins. Methods In 50 severe multiple trauma patients admitted to emergency intensive care unit from Decem- her 2004 to December 2005 and 27 healthy volunteers,size of bilateral IJV was measured with ultrasonog- raphy at the end of inspiration and expiration,under controlled ventilation to compare size of IJV,influen- tial factors and distribution of dominant veins.Results Size of bilateral IJV was more markedly in- creased in multiple trauma patients than that in control group.There were 37 patients(74%)with dominant veins on the right side and 13 on the left side,in which three patients with size of IJV less than 0.40 cm~2 on each side,without statistical difference compared with normal volunteers.The size of IJV in normal volunteers was correlated with age,body height and weight,but those in multiple trauma patients did with mainly central venous pressure and mechanical ventilation.Conclusions IJV is asymmetric in severe multiple trauma patients and larger than that in normal volunteers.Ultrasonography before IJV catheterization and adoption of inspiratory panse during catheterization will contribute to successful catheterization.