Mahlon Michael A, Yoon Hyo-Chun
Department of Radiology, Tripler Army Medical Center, Honolulu, Hawaii, USA.
J Vasc Interv Radiol. 2007 Sep;18(9):1106-10. doi: 10.1016/j.jvir.2007.06.002.
To determine normative data for radiographic landmarks of the superior vena cava (SVC) and the location of the junction of the SVC with the right atrium for use in the placement of central venous catheters.
The authors retrospectively reviewed 112 pulmonary computed tomographic (CT) angiograms obtained in seven men and seven women from each decade of life between the ages of 20 and 99 years. For each patient, the length of the SVC was measured from its origin to the cavoatrial junction. The distances from the carina and right tracheobronchial angle to the cavoatrial junction and the origin of the SVC were also measured. Interobserver variation in choosing the location of the carina and tracheobronchial angle was analyzed.
The mean length (+/-standard deviation) of the SVC was 70.7 mm +/- 14.1. The mean distance from the superior margin of the SVC to the carina was 30.4 mm +/- 11.2, from the carina to the cavoatrial junction 40.3 mm +/- 13.6, from the superior margin of the SVC to the right tracheobronchial angle 21.7 mm +/- 10.8, and from the right tracheobronchial angle to the cavoatrial junction 49.0 mm +/- 13.6. There was a statistically significant difference in interobserver variation in selecting the location of the right tracheobronchial angle as compared to choosing the carina.
Placement of the central venous catheter tip at or just below the level of the carina during inspiration ensures placement in the SVC. Placement of the central venous catheter tip approximately 4 cm below the carina will result in placement near the cavoatrial junction.
确定上腔静脉（SVC）影像学标志的规范数据以及SVC与右心房交界处的位置，以用于中心静脉导管的放置。
作者回顾性分析了112例肺计算机断层扫描（CT）血管造影图像，这些图像来自年龄在20至99岁之间、每个十年年龄段各7名男性和7名女性。对于每位患者，测量SVC从其起始点到腔房交界处的长度。还测量了隆突和右气管支气管角到腔房交界处以及SVC起始点的距离。分析了观察者在选择隆突和气管支气管角位置时的差异。
SVC的平均长度（±标准差）为70.7 mm±14.1。SVC上缘到隆突的平均距离为30.4 mm±11.2，从隆突到腔房交界处为40.3 mm±13.6，从SVC上缘到右气管支气管角为21.7 mm±10.8，从右气管支气管角到腔房交界处为49.0 mm±13.6。与选择隆突相比，观察者在选择右气管支气管角位置时的差异具有统计学意义。
吸气时将中心静脉导管尖端放置在隆突水平或其稍下方可确保导管放置在上腔静脉内。将中心静脉导管尖端放置在隆突下方约4 cm处将使其靠近腔房交界处。
