经贵要静脉行PICC置管的解剖观察

目的为临床上行贵要静脉穿刺术,提高穿刺成功率提供贵要静脉的应用解剖学资料。方法:选取经福尔马林浸泡的成人尸体标本33例共66侧。逐层解剖上肢,暴露贵要静脉。用游标卡尺来测量贵要静脉的长度和外径。并观察贵要静脉的起始情况,贵要静脉与相关神经及动脉之间的关系。结果贵要静脉长度,男性约335.01mm,女性约331.50mm;贵要静脉在前臂中部管径,男性约1.90mm,女性约1.85mm;贵要静脉接肘正中静脉处管径,男性约2.35mm,女性约2.26mm;贵要静脉末端管径,男性约2.90mm,女性约2.60mm。贵要静脉多数起于手背尺侧缘,少数起于第1手背静脉汇合处,后沿前臂尺侧上行,在肘窝下方转向前面,接收肘正中静脉后,经肱二头肌内侧沟上行至臂中部,穿深筋膜汇入肱静脉。贵要静脉深面是肱二头肌腱膜,此腱膜将贵要静脉与肱动脉、正中神经隔开,贵要静脉可跨过前臂内侧皮神经,前臂内侧皮神经亦可跨过贵要静脉。结论在肘部抽血时,如遇肘正中静脉缺如,以穿刺贵要静脉为宜;穿刺置管时如遇头静脉插管困难,以选择贵要静脉为宜。

Anatomical observation of peripherally inserted central venous catheters for the basilic vein

Objective To provide the anatomical data of the basilic vein for improving the success rate of the venipuncture.Methods Totally 33 cases adult cadavers(66 sides) soaked by formalin were observed.The basilic veins were exposed carefully;their diameter and length were measured with vernier caliper.Meanwhile,the origin and the adjacence of the basilic vein were also observed.Results The length of basilic veins were about 335.01 mm in men,and about 331.50 mm in women;the diameter of the basilic vein in median forearm was about 1.90 mm in man,and about 1.85 mm in woman;the diameter of the basilic vein adjacent to the medial cubital vein was about 2.35 mm in male,and about 2.26 mm in female;the diameter of the proximal part of basilic vein was about 2.90 mm in male,and about 2.60 mm in female.The majority origins of the basilic vein were in the ulnar margin of the back hand,and a few were from the back of the adjacent finger.Rising along the ulnar forearm,the basilica vein migrated anteriorly,receiving median cubital vein,and then went through the the medial sulcus of biceps up to the median upper arm through the deep fascia to join the brachial vein.The aponeurosis bicipitalis lay in deep of the basilic vein,which separated the basilica vein from brachial artery and the median nerve.In addition,the basilic vein could cross above or below the medial antebrachial cutaneous nerve.Conclusion Hemospasia from elbow and puncture from the basilica vein are the well choice if the median cubital vein is absencet.Venipuncture through basilic vein is suitable when the cephalic vein intubation is difficult.