超声引导颈内静脉穿刺与解剖定位穿刺方法的比较

目的：探讨颈内静脉穿刺术病人的最佳头位,比较超声引导与传统体表标志定位（中路法）在确定具体穿刺点和进针方向上的区别。方法：选择择期妇科手术患者100例．取头位0°，左偏30°和左偏最大角度时．分别测量右侧颈内静脉直径．颈总动脉直径、颈内静脉覆盖颈总动脉的宽度及颈总动脉中点与颈内静脉中点的距离．以上数据均为投影在冠状面的冠状轴长度。计算动静脉重叠率．动静脉重叠率（％）=颈内静脉覆盖颈总动脉宽度（cm）／颈总动脉宽度（cm）×100％。同时分别依据体表标志和超声定位确定右颈内静脉穿刺点和进针方向。比较两种定位方法穿刺点之间的距离和进针方向之间的角度。结果：不同头位时右颈内静脉直径无明显变化（P〉0．05）。头部正中位和头部左偏30°时,颈总动脉无明显变化（P〉0．05），动静脉重叠率增加（P〈0．05）．动静脉中点距离减小（P〈0．05）。头部左偏最大角度与头部正中位及头部左偏30°比较．颈总动脉直径明显变小（P〈0．01）．动静脉重叠率明显增加（P〈0．01）．动静脉中点距离明显减小（P〈0．01）。超声定位与体表标志定位法相比．两者穿刺点之间的距离为9．7±5．8ram．两者穿刺方向之间的角度为25．9±10．7°。结论：解剖标志定位与超声定位穿刺点和穿刺方向均存在较大差别．在无超声定位引导条件下，按传统穿刺方法．如果多次穿刺来成功应该考虑将穿刺点外移9．7mm左右．且穿刺方向指向锁骨上切迹。其次．随着头位左偏角度的逐渐增大，穿刺条件逐渐变差．穿刺时左偏角度不应超过30°。

A Comparison of Ultrasound Guided Puncture and Anatomical Localization Puncture of the Intemal Jugular Vein

Objective： The study was designed to compare of Ultrasound guided puncture and anatomical localization puncture of the internal jugular vein, and to access the best head position for the puncture. Methods： One hundred patients undergoing Gynecological operation midpoint between the internal jugular vein and carotid artery were recorded point of puncture and the angle of the puncture. The diameter of internal jugular vein and carotid artery, the interval of the Calculate the rate of artery-vein overlap. Compare the two methods with the Results： Along with the angle of the head was adding, the diameter of internal jugular was no significant change, but diameter of carotid artery was diminished, interval of the midpoint between the artery and vein was significant diminished, the rate of artery-vein overlap was significant increase. Compare the two puncture methods, the interval of the point of puncture was 9.7±5.8mm, and the angle of the puncture was 25.9±10.7°. Conclusion： Compare the two methods with the point of puncture and the angle of the puncture were significant different, suggest that the point of puncture move toward outside about 9.7±5.8mm and the direction of puncture direct clavicular notch. Along with the angle of the head, the condition of puncture is disadvantaged.