Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 120-752, South Korea.
J Crit Care. 2010 Jun;25(2):360.e9-360.e13. doi: 10.1016/j.jcrc.2009.12.005. Epub 2010 Feb 10.
The aim of this study was to evaluate the influence of head rotation on the relative anatomy of internal jugular vein (IJV) and carotid artery (CA) in infants and children.
Two hundred pediatric patients (26.5 +/- 23.3 months old) who were undergoing elective surgery were eligible for this consecutive and prospective study. Using 2-dimensional ultrasound, the amount of overlap and the relative position of the 2 vessels were compared between heads in the neutral position and in 90 degrees of rotation.
The mean percentage overlap of CA by IJV in the neutral position increased significantly as the head was rotated to the right (23.3% vs 39.2%) and left (35.3% vs 52.8%). The incidence of lateral positioning of IJV to CA decreased significantly when the head was rotated (40% vs 21% in right, 26.5% vs 10.5% in left). The right IJV is associated with less overlap of the CA than the left, regardless of head position.
The head should be kept in as near a neutral position as possible because the overlap increased by head rotation in both sides. In addition, the right IJV should be preferred because of less CA overlap and more lateral positioning than the left.
本研究旨在评估头旋转对婴儿和儿童颈内静脉（IJV）和颈总动脉（CA）相对解剖结构的影响。
本连续前瞻性研究纳入了 200 名接受择期手术的儿科患者（26.5±23.3 个月）。使用二维超声比较头中立位和旋转 90°时 2 条血管的重叠量和相对位置。
头向右侧旋转时，CA 被 IJV 重叠的平均百分比显著增加（23.3%对 39.2%），向左旋转时也有类似的增加（35.3%对 52.8%）。当头部旋转时，IJV 向 CA 外侧移位的发生率显著降低（右侧 40%对 21%，左侧 26.5%对 10.5%）。无论头位如何，右侧 IJV 与 CA 的重叠均少于左侧。
由于头旋转会导致两侧重叠增加，因此头应保持尽可能接近中立位。此外，由于右侧 IJV 与 CA 的重叠较少，且更偏向外侧，因此应优先选择右侧 IJV。
