颈内静脉的影像学调查及颈总动脉旁颈内静脉穿刺法的研究

目的　探讨颈内静脉穿刺的最佳部位和方法。方法　随机抽取 31例无劲、胸疾患的成年患者颈部核磁共振图像和 2 0位青年志愿者颈部超声图像 ,取甲状软骨上缘、环状软骨、第七颈椎三个横截面的图像 ,分别观察和测定动、静脉的前后关系、动、静脉的内外关系、静脉到皮肌的距离。对 1 2 4例需要行中心静脉置管的患者采用颈总动脉旁颈内静脉穿刺法穿刺。结果　颈总动脉与颈内静脉紧密相连 ;颈内静脉有从上到下依次在动脉的后面过渡到平行、前面的趋势 (P <0 0 1 ) ;三个平面自上而下颈内静脉前壁与颈前皮肤的距离依次变短 (P <0 0 1 )。本组 1 2 4例患者穿刺成功 1 2 3例 ,成功率 99% ,无任何并发症。结论　环状软骨平面颈总动脉外侧 0 5cm处为颈内静脉穿刺的最佳进针点 ;颈总动脉旁颈内静脉穿刺法具有定位明确、操作安全、方便等优点

Study of internal jugular vein imaging and the internal jugular vein puncture method

Objective To search the optimal site and the best internal jugular vein puncture methold.Methods The cervical nuclear magnetic images of 31 adults and the ultrasound images of 20 young volunteers were randomly selected.The adjacent relatioship between the common carotid artery and the internal jugular vein at three cross sections(the upper border of the thyroid cartilage,the cricoid cartilage and the seventh cervical vertebra transverse section)was analyzed.The distance from the internal jugular vein to skin was also determined.A exterior_lateral carotid approach for jugular vein puncture and catheterization was carried out on 124 patients.Results The internal jugular vein(IJV) and the common carotid artery(CCA)join tightly to each other.From the top down,the IJV is behind the CCA,then parallels to the latter,in the last cross section it is in front of the CCA.From the upper border of the thyroid cartilage to the seventh cervical vertebra area,the distance beween the IJV and skin becomes gradually shorter.Among the 124 cases,one hundred and twenty three(99%)were successfully punctured without any complication.Conclusion The optimal site of internal jugular vein puncture is 0 5cm from the common carotid artery at the cricoid cartilage transverse section.Paracommon carotid artery internal jugular vein puncture is an accurate,simple,safe and effective puncture method.