不同年龄段患儿双侧颈内静脉与颈总动脉解剖关系的比较

摘要

目的 应用超声技术观察并比较不同年龄段患儿双侧颈内静脉与颈总动脉的解剖关系.方法 选择择期手术患儿496例,男380例,女116例,年龄0~12岁,ASA Ⅰ或Ⅱ级.应用超声技术探测锁骨水平上颈内静脉与颈总动脉的影像位置,将颈内静脉相对于颈总动脉位置按照角度划分为5个区域:0°~30°(最利于穿刺)、30°~60°(利于穿刺)、60°~90°、90°(定义为重叠)、>90°(定义为变异).比较不同年龄段组[新生儿组(0~1个月)、婴儿组(1月~1岁)、幼儿组(1~3岁)、学龄前儿童组(3~6岁)和学龄儿童组(6~12岁)]患儿中双侧颈内静脉与颈总动脉的解剖关系.结果 在0°~30°区域,婴儿组、幼儿组、学龄前儿童组和学龄儿童组患儿中右侧所占比例明显高于左侧(婴儿组:42.3% vs 0%;幼儿组:48.8% vs 1.6%;学龄前儿童组:57.5% vs 2.7%;学龄儿童组:58.0% vs 2.1%)(P<0.01);在30°~60°区域,各年龄段组患儿右侧所占比例均明显高于左侧(新生儿组:45.0% vs 10%;婴儿组:44.2% vs 23.1%;幼儿组:46.3% vs 19.5%;学龄前儿童组:35.4% vs 19.5%;学龄儿童组:35.1% vs 20.2%)(P<0.05或P<0.01);在60°~90°和90°区域,婴儿组、幼儿组、学龄前儿童组和学龄儿童组患儿右侧所占比例明显高于左侧(P<0.01);在>90°区域,各年龄段组患儿右侧所占比例与左侧差异无统计学意义.结论 患儿右侧颈内静脉与颈总动脉的解剖关系比左侧更利于穿刺,新生儿与其他年龄段患儿有所不同.%Objective To observe and compare anatomical position between pediatric internal jugular vein and common carotid artery in children patients of different ages with ultrasonic technique.Methods Four hundred and ninety-six cases of pediatric patients undergoing selective operation,ASA physical status Ⅰ or Ⅱ,were selected in this study,they were 380 males and 116 females ranging from 0 to 12 years.Image position of internal jugular vein and common carotid artery above the clavicle were detected with ultrasonic technique for all pediatric patients,positions of internal jugular vein and common carotid artery for different patients were classified according to different angles,anatomical position between pediatric internal jugular vein and common carotid artery in different age groups (newborn group,infant group,toddler group,preschool children group and school-age children group) were compared.Results In area between 0°-30°,the ratios of right puncture of infant group,toddler group,preschool children group and school-age children group were significantly higher than those of the left (infant group: 42.3% vs 0%;toddler group: 48.8% vs 1.6%;preschool children group: 57.5% vs 2.7%;school-age children group: 58.0% vs 2.1%)(P<0.01).In area between 30°-60°,the ratios of the right puncture in all groups were significantly higher than those of the left (newborn group: 45.0% vs 10%;infant group: 44.2% vs 23.1%;toddler group: 46.3% vs 19.5%;preschool children group: 35.4% vs 19.5%;school-age children group: 35.1% vs 20.2%) (P<0.05 or P<0.01).In areas between 60°-90°and at 90°,the ratios of the right puncture in infant group,young children group,preschool children group and school-age children group were significantly higher than those of the left (P<0.01).In areas of >90°,there was no statistical difference between the ratios of the right puncture and the left in all groups.Conclusion The success rate of right internal jugular vein puncture of children was higher than that of the left.Conditions in the newborn group were different from that in the other age groups.