CAJ | 학술논문

目的：应用超声技术研究中心静脉穿刺患者颈内静脉与颈总动脉位置关系的影响因素，为提高穿刺成功率提供依据。方法于2014年1-6月选择我院需要中心静脉穿刺的择期手术患者150例，应用超声波扫描术，在胸锁乳突肌胸骨头与锁骨头顶点位置，头部偏转0°、30°、60°和最大角度，测定不同转头角度双侧颈内静脉与颈总动脉的夹角和动脉重叠率，并分析不同年龄、性别、体质量指数对其的影响。结果超声影像显示，随患者转头角度的增加，颈内静脉从颈总动脉外侧逐渐移向颈总动脉前面，即双侧颈内静脉与颈总动脉的夹角逐渐减小(P＜0.01)，动脉重叠率逐渐增加(P＜0.01)。相同转头角度下，右侧动静脉夹角均大于左侧(P＜0.01)，而动脉重叠率均小于左侧(P＜0.01)。患者头中立位(0°)和转头30°时，女性动脉重叠率大于男性(P＜0.05)；高龄患者动脉重叠率大于低龄患者(P＜0.05)；不同转头角度，大体质量指数患者动脉重叠率均大于小体质量指数患者(P＜0.05)。结论颈内静脉与颈总动脉的解剖关系随转头角度而发生位置变化，并受年龄、性别和体质量指数的影响。前、中入路穿刺时，转头30°即可；后路穿刺时，尽可能向对侧做最大转头，更易避开动脉。
목적：응용초성기술연구중심정맥천자환자경내정맥여경총동맥위치관계적영향인소，위제고천자성공솔제공의거。방법우2014년1-6월선택아원수요중심정맥천자적택기수술환자150례，응용초성파소묘술，재흉쇄유돌기흉골두여쇄골두정점위치，두부편전0°、30°、60°화최대각도，측정불동전두각도쌍측경내정맥여경총동맥적협각화동맥중첩솔，병분석불동년령、성별、체질량지수대기적영향。결과초성영상현시，수환자전두각도적증가，경내정맥종경총동맥외측축점이향경총동맥전면，즉쌍측경내정맥여경총동맥적협각축점감소(P＜0.01)，동맥중첩솔축점증가(P＜0.01)。상동전두각도하，우측동정맥협각균대우좌측(P＜0.01)，이동맥중첩솔균소우좌측(P＜0.01)。환자두중립위(0°)화전두30°시，녀성동맥중첩솔대우남성(P＜0.05)；고령환자동맥중첩솔대우저령환자(P＜0.05)；불동전두각도，대체질량지수환자동맥중첩솔균대우소체질량지수환자(P＜0.05)。결론경내정맥여경총동맥적해부관계수전두각도이발생위치변화，병수년령、성별화체질량지수적영향。전、중입로천자시，전두30°즉가；후로천자시，진가능향대측주최대전두，경역피개동맥。
Objective To evaluate the influential factors of relationship between internal jugular vein (IJV) and common carotid artery (CCA) by ultrasonography in order to increase the success rate of puncture.Methods One hundred andfifty elective surgical patients in our hospital from January to June in 2014 who required central venous access were included in this study. The angle between IJV and CCA and the overlap of CCA at the apex of triangle formed by sternocleidomastoid muscle at 0°, 30°, 60° and maximum head rotation were analyzed by ultrasonography. The effects of age, gender and body mass index (BMI) on the CCA overlap were also analyzed.Results With the increased head rotation, the IJV moved from the lateral to the front of CCA, so the angle between IJV and CCA becamesmaller (P<0.01) and the percent overlap of CCA and IJV were gradually increased at both sides (P<0.01). Compared with the left side at the same degree of head rotation, the angle between IJV and CCA was greater and the percent overlap of CCA was lower on the right side (P<0.01). Female and elderly patients were associated with more overlap of CCA at head rotations of 0° or 30° (P<0.05). The overlap rate of CCA in high BMI patients at any head rotations were higher than that of low BMI patients (P<0.05).Conclusion The relationship between IJV and CCA changes with head rotation and is easily influenced by age, gender and BMI. Head rotation should be limited to 30° when using the anterior or central approach and head should be rotated to maximum degree when using posterior approach in order to avoid inadvertent puncture of CCA.