上肢静脉入路PICC置管术应用解剖学研究

摘要

目的 研究PICC置管术涉及到的上肢静脉的走行、体表解剖标志的定位,为置管术安全、准确、顺利进行提供相应的解剖学依据.方法 解剖64具成人尸体(男49具、女15具)双侧上肢标本,分离头静脉、肘正中静脉、贵要静脉,观测肘下2横指至上腔静脉入口段PICC走行静脉的合成、周径(切开静脉后测量其宽度)、属支及静脉瓣等情况.结果 头静脉周径左侧(7.78±2.55)mm,右侧(7.35±1.65)mm;贵要静脉左侧(8.04±1.95)mm,右侧(7.84±1.74)mm;左右侧差异无统计学意义.头静脉入路瓣膜数量左侧:(8.38±1.70)个,右侧:(8.23±1.46)个;贵要静脉入路瓣膜数量左侧:(6.46±1.21)个,右侧:(6.13±1.24)个.根据肘正中静脉汇入不同大致可分为:Ⅰ型均衡型(39%),前臂浅静脉借"M"或"Y"形与贵要静脉和头静脉相连;Ⅱ型贵要静脉型(32%),前臂浅静脉直接注入贵要静脉或与上臂头静脉相连;Ⅲ型头静脉型(7%),前臂浅静脉直接注入头静脉;Ⅳ型缺如型(22%),头静脉和贵要静脉在肘部不相连者.结论 PICC置管时应根据患者个体肘正中静脉汇入类型及角度差异,个体化选择置管静脉.建议选择贵要静脉为好,头静脉入路不宜作为PICC置管首选.在选择右侧入路进行PICC置管时,应嘱患者头偏向右侧,使颈内静脉与头臂静脉不在一条直线上,以防止导管反折入颈内静脉.%Objective To provide morphological evidences for peripherally inserted central catheter (PICC). Methods A morphometric investigation on 64 Chinese cadavers (49 Male, 15 Female) of veins of upper limb was conducted with dissection method. Results The inner circumference of the cephalic veins at the interepicondylar line was (7.78±2.55)mm on the left side and (7.35±1.65)mm on the right side ; the inner circumference of the basilic veins at the interepicondylar line was (8.04±1.95)mm on the left side and (7.84±1.74)mm on the right side. There were no significant differences between the right and left sides. The number of venous valves for cephalic vein approach was 8.38±1.70 on the left side and 8.23±1.46 on the right side. The number of venous valves for basilic vein approach was 6.46±1.21 on the left side and 6.13±1.24 on the right side. Based on the 64 cadavers in the series, superficial veins were classified into four types. The patterns observed were the following: Type Ⅰ (39％), the cephalic vein communicating through the median cubital vein with the basilic vein in the elbow region; Type Ⅱ (32％):the forearm superficial veins draining into the basilic vein in the elbow region; Type Ⅲ(7％): the forearm superficial veins draining into the cephalic vein in the elbow region; Type Ⅳ(22％): the cephalic and the basilic veins without any direct communication in the elbow region. Conclusion The intubations of PICC should combine with patients ' specific vein types, which could improve the successful intubation rates of PICC. Basilica vein, instead of cephalic vein approach, is a hetter choice for PICC. And patients are supposed to turn their heads in the right once the intubation of PICC is carried out on the right side, which could prevent internal jugular vein and brachiocephalic vein in one straight line.