体位对颈内静脉横截面积的影响

摘要

Objective To investigate the effects of the site for access to internal jugular vein (lateral versus anterior),lying position of patients (supine versus Trendelenburg),and head rotation (0°,20°,and maximum) during central venous catheterization on the location depth and cross-sectional area (CSA) of the right internal jugular vein (IJV).Methods Fifteen healthy volunteers were recruited in this prospective observational study from September 2008 to October 2008.Healthy volunteers were placed in flat supine position and 15°.Trendelenburg position separately.In each position,IJV were measured ultrasonographically from lateral site and anterior site with the head oriented at 0°,20°,and maximum rotation separately.Data of measured CSA and location depth of internal jugular vein in different positions were compared.Results The largest CSA (2.16 ±0.89) cm2 and location depth [(1.38 ± 0.43)cm] were occurred at the lateral approach in Trendelenburg position with head oriented at maximum rotation.The CSA in Trendelenburg position was larger than that in flat supine position.Only at the maximum head rotation,lateral approach got statistically larger CSA.The effects of head rotation varied with different degrees of rotation.Conclusions Site of approach,lying position and head rotation had noticeable effects on internal jugular vein cross-sectional area.Trendelenburg position increased the CSA of IJV.%目的 了解颈内静脉(internal jugular vein,IJV)穿刺过程中入路(侧路与前路),患者体位(平卧位与垂头仰卧位)和头部转动角度(0°,20°,最大角度)对于IJV横截面积(cross-sectional area,CSA)、直径和深度的影响.方法 前瞻观察性研究,2008年9月至10月共纳入15名健康志愿者参与本研究.分别于平卧位和15°垂头仰卧位时,依次转动头部至0°,20°和最大角度,使用超声分别经前路与侧路测量IJV CSA、直径和深度,并比较各种体位情况下IJVCSA、直径和深度的差别.结果 垂头仰卧位、头部转动最大角度、侧路时IJV CSA最大(2.16±0.89) cm2,深度最深(1.38±0.43) cm.相同头部转动角度、入路情况下,垂头仰卧位的IJVCSA均大于平卧位.侧路对IJV CSA影响仅在头部转动最大角度时显著.头部转动角度仅在部分情况下对IJV CSA有影响.结论 体位、头部转动角度、入路对于IJV CSA和直径有影响.垂头仰卧位对IJV CSA影响较显著.