不同左偏头位下右侧颈内静脉与颈总动脉的关系分析

目的 应用超声比较不同角度左偏头位下右侧颈内静脉在3个穿刺入路位点(前、中、后)与颈总动脉的位置关系,探讨患者的最佳头位.方法 选取120例患者,应用超声测量头部正中位(0°)和左偏15°、30°、45°、60°时,前、中、后穿刺位点的颈内静脉直径、颈总动脉直径、颈内静脉覆盖颈总动脉距离及颈总动脉中点与颈内静脉中点之间的距离(动静脉中点距离),计算颈内静脉无重叠百分比.结果 头部不同旋转角度下,3个穿刺位点颈内静脉与颈总动脉直径均无明显变化(P>0.05).后路穿刺位点在不同角度下无重叠百分比、动静脉中点距离均无明显变化(P>0.05);但在同样角度下,其无重叠百分比要小于前路和中路(P<0.05).前路、中路穿刺位点,无重叠百分比与动静脉中点距离在0°、15°、30°之间比较,差异无统计学意义(P>0.05),而当旋转角度达到45°和60°时与前3个角度比较,无重叠百分比明显减小(P<0.05),动静脉中点距离明显减小(P<0.05),且随着旋转角度的增大,两者的数值也逐渐减小(P<0.05).结论 在无超声定位的情况下行右侧颈内静脉穿刺,为减少误穿动脉的风险,应尽量选择前路和中路,同时应避免头位左偏大于45°.

Spatial distances between internal jugular vein and carotid artery vary with rotating angles of the neck

Objective To utilize ultrasound as an approach to determine spatial distances between the right internal jugular vein and carotid artery at anterior, middle and posterior puncture sites when the neck turned to the left at various angles. Methods One hundred and twenty patients, classified as ASA ⅠorⅡ, were enrolled in this study. All subjects lay in supine and with a 5 cm thick pads under the shoulder. Ultrasound was used to determine the diameters of the right internal jugular vein and carotid artery, the proportions of right internal jugular vein spatially overlapping carotid artery, and the distances between the middle of right internal jugular vein and carotid artery (arteriovenous midpoint distance), at anterior, middle and posterior puncture sites when patient's neck turned to the left at angles of 0°, 15°, 30°, 45° and 60°. Results The diameters of the right internal jugular vein and carotid artery, proportions of right internal jugular veins non-overlapping with carotid arteries, and arteriovenous midpoint distance did not vary with puncture sites and turning angles. But at the same turning angles, percentages of right internal jugular veins non-overlapping with carotid arteries at the posterior puncture site were less than those at the anterior and middle puncture sites (P<0.05). At the anterior and middle puncture sites, percentages of right internal jugular vein non-overlapping with carotid arteries, and arteriovenous midpoint distances were similar at the turning angles of 0°, 15°, and 30°. But when the turning angles reached 45° and 60°, the percentages of right internal jugular vein non-overlapping with carotid arteries and arteriovenous midpoint distance were significantly decreased (P<0.05). Conclusions The spatial distances between the right internal jugular vein and carotid arteries reduced when the turning angles of the neck exceeded 45°, and at the posterior puncture site. To avoid the risk of puncturing carotid artery, operators should choose anterior or middle puncture sites and restrain the turning angle of the neck within 45°.