锁骨下静脉穿刺定位新标志的放射解剖学和临床研究

目的 采用放射解剖学方法探讨锁骨下静脉穿刺(锁骨下径路)的新定位标志和方法.方法 85例患者行相关标志的放射解剖学和实际体表测量,进行校正、比较和分析,提出新的定位标志.采用区组随机法,8位初学者分别采用新方法和传统方法共穿刺168例患者,比较其穿刺成功率.结果 A点(胸锁乳突肌锁骨头外缘与锁骨下缘交点)、B点(喙突-体表中线距离的中线与锁骨下缘交点)、C点(胸大肌三角肌顶点-体表正中线距离中点处的锁骨下缘)离锁骨下静脉与锁骨下缘交点(D点)解剖距离近;初学者采用新方法成功率显著提高(P=0.009),穿刺时间显著减少 (P=0.001).结论 A点、B点和C点可作为锁骨下静脉穿刺的定位参考,初学者采用新定位标志和方法可显著提高穿刺成功率,减少穿刺时间.

Novel landmarks for subclavian vein cannulation: a radiologic-anatomic and clinical study

Objective　To investigate the novel and optimal landmarks for a subclavian vein cannulation (SVCA). Methods　We conducted the study including three phases: ①Various possible markers for SVCA were evaluated by anatomic measurements in vivo and the course of SV was evaluated by radiologic means; Results acquired by the two means were compared and adjusted, then the novel landmarks and a new approach for SVCA were proposed. ③The efficacy of the new approach for SVCA was compared with that of traditional one by a prospective, randomized, controlled study. Results　Point A (the junction of the lateral border of sternocleidomastoideus clavicular head and inferior border of clavicle), point B (a point on the lower border of clavicle just above the middle of the line joining the coracoid process and midline of the body), and point C (a point on the lower border of clavicle above the middle of line joining the apex of the cleft formed by ectopectoralis and deltoid muscles and midline of the body) were relatively close to point D (where subclavian vein crosses the inferior border of clavicle). The novel approach had significantly higher success rate (80.9% vs.70.2%,P=0.008); the time of cannulation by new method was significant shorter than that by a traditional one (5.9±6.8) minutes vs.(10.4±2.5) minutes, P=0.001]. Conclusion　Point A, B, and C could be considered as landmarks for identifying puncture site for SVCA. The novel approach applied in the beginners for SVCA could significantly reduce operation time and increase success rate.