头静脉汇入腋静脉或锁骨下静脉夹角对经头静脉入路PICC置管术的影响

目的　探讨头静脉汇入腋静脉或锁骨下静脉夹角对经头静脉入路上肢外周静脉穿刺中心静脉置管（peripherally inserted central catheters，PICC）操作的影响。 方法　解剖38具（76侧）捐献者遗体，测量和分析上肢外展0 °和90 °时男、女两侧头静脉汇入腋静脉或锁骨下静脉的夹角。 结果　头静脉汇入腋静脉或锁骨下静脉的前外侧壁，汇入处管径平均为（7.27±2.94）mm，95%可信区间为6.51~8.03 mm，夹角有锐角、直角和钝角3种类型。上肢外展0 °时，夹角平均为（47.14±27.02）°，95%可信区间为40.97°~63.32°；上肢外展90°时，夹角平均为（63.88±24.26）°，大于上肢外展0°时夹角，95%可信区间为53.96°~65.64°。上肢外展0°时，男、女夹角无明显差异，而上肢外展90°时男性夹角大于女性夹角。上肢外展0°和90°时，左、右侧夹角均无明显差异。 结论　经头静脉入路PICC术时，男、女两侧头静脉汇入腋静脉或锁骨下静脉的夹角不影响导管通过，但有少部分人夹角接近或大于90°，尤其男性上肢外展90°可能增加导管通过夹角的难度，操作中需加以注意。

Effect of the angle between cephalic vein and axillary vein or subclavian vein on PICC catheterization through cephalic vein approach

Objective　To explore the effect of the angle between cephalic vein and axillary vein or subclavian vein on PICC catheterization through cephalic vein approach.　Methods　A total of 38 (76 sides) cadaver donors were dissected, and the angle changes between cephalic vein and axillary vein or subclavian vein of male or female were measured and analyzed at 0° and 90° of upper limb abduction. Results The average diameter of cephalic vein into the anterior lateral wall of the axillary vein or subclavian vein was (7.27±2.94) mm, 95% confidence interval (95%CI) was (6.51~8.03) mm. The included angle between cephalic vein and axillary vein or subclavian vein has the following 3 types: acute angle, right angle and obtuse angle. When the upper limb abduction reached 0°, the included angle was (47.14±27.02) ° on average, the 95% CI was 40.97°~ 63.32°. However, the upper limb abduction reached 90°, the included angle was (63.88±24.26) ° on average, which was greater than when the upper limb abduction reached 0°, and the 95% CI was 53.96°~ 65.64°. There was no significant difference in the included angles between male and female with upper limb abduction at 0°, while the included angle of male was greater than that of female with upper limb abduction at 90°. At 0° and 90° of upper limb abduction, there was no significant difference in the angle between left and right sides.　Conclusions　The included angle of both male and female between cephalic veins and axillary vein or subclavian vein does not affect the duct to pass through during PICC catheterization through cephalic vein approach. However, in a few cases, the included angle is close to or greater than 90°, especially the male upper limb abduction 90° may increase the difficulty of catheter passing through the included angle, which should be paid attention to during operation.