Roth Benjamin, Marciniak Bruno, Engelhardt Thomas, Bissonnette Bruno
Pôle d'Anesthésie Réanimation, Hôpital Jeanne de Flandre, CHRU Lille, France.
Paediatr Anaesth. 2008 Nov;18(11):1045-9. doi: 10.1111/j.1460-9592.2008.02767.x.
Central venous cannulation (CVC) in young children is technically difficult and may lead to potentially serious complications especially when performed blindly or using anatomical landmarks only. The aim of this study was to determine the anatomical relationship of the internal jugular vein (IJV) and the common carotid artery (CA) in preschool children using ultrasound.
Forty-five children aged 60 months and under were included prospectively and divided into three groups: Group 1: <6 months, Group 2: 7-18 months and Group 3: 19-60 months. With the head in neutral position the location of the left and right IJV was noted as anterior, anterolateral (AL), lateral or medial in relation to the CA at the level of the cricoid cartilage. Depths of IJV and CA as well as time taken to locate the vessels were recorded.
The IJV was more commonly found in the AL position in all groups. The mean depth was 0.96 cm in Group 1, 0.95 cm in Group 2 and 3. Mean duration for localization of the vessels was 4.2 s in Group 1, 4 s in Group 2 and 4.3 s in Group 3. The differences between the groups were not significant.
This study demonstrates that the IJV cover the CA in the majority of young children. Depth of the IJV is rarely more than 1 cm deep to the skin. Ultrasound location of the IJV and CA is easy and does not necessarily delay the procedure. The findings of this study support the use of ultrasound guidance for CVC in children.
幼儿中心静脉置管(CVC)在技术上具有挑战性,可能会导致潜在的严重并发症,尤其是在盲目操作或仅使用解剖标志进行操作时。本研究的目的是使用超声确定学龄前儿童颈内静脉(IJV)和颈总动脉(CA)的解剖关系。
前瞻性纳入45名60个月及以下的儿童,并将其分为三组:第1组:<6个月;第2组:7 - 18个月;第3组:19 - 60个月。在头部处于中立位置时,在环状软骨水平记录左、右颈内静脉相对于颈总动脉的位置,分为前、前外侧(AL)、外侧或内侧。记录颈内静脉和颈总动脉的深度以及定位血管所需的时间。
在所有组中,颈内静脉更常见于前外侧位置。第1组的平均深度为0.96 cm,第2组和第3组为0.95 cm。第1组定位血管的平均持续时间为4.2秒,第2组为4秒,第3组为4.3秒。各组之间的差异不显著。
本研究表明,在大多数幼儿中,颈内静脉覆盖颈总动脉。颈内静脉深度很少超过皮肤表面1 cm。超声定位颈内静脉和颈总动脉很容易,且不一定会延迟操作。本研究结果支持在儿童中心静脉置管中使用超声引导。