特伦德伦堡体位和呼气末正压对颈内静脉横截面积的影响。

The impact of Trendelenburg position and positive end-expiratory pressure on the internal jugular cross-sectional area.

机构信息

Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.

出版信息

Anesth Analg. 2010 Aug;111(2):432-6. doi: 10.1213/ANE.0b013e3181e2fe41. Epub 2010 May 19.

DOI:10.1213/ANE.0b013e3181e2fe41

PMID:20484538

Abstract

BACKGROUND

Increasing the cross-sectional area (CSA) of the right internal jugular vein facilitates cannulation and decreases complications. Maneuvers such as the Trendelenburg tilt position and ventilation with a positive end-expiratory pressure (PEEP) may increase the CSA of the right internal jugular vein. We determined the changes in the CSA in response to different maneuvers.

METHODS

The CSA (cm(2)) of the right internal jugular vein was assessed in 50 anesthetized adult cardiothoracic surgery patients using 2-dimensional ultrasound. First, the CSA was measured in response to supine position with no PEEP (control condition, S0) and compared with 5 different randomly ordered maneuvers: (1) PEEP ventilation with 5 cm H(2)O (S5), (2) PEEP with 10 cm H(2)O (S10), (3) a 20 degrees Trendelenburg tilt position with a PEEP of 0 cm H(2)O (T0), (4) a 20 degrees Trendelenburg tilt position combined with a PEEP of 5 cm H(2)O (T5), and (5) a 20 degrees Trendelenburg tilt position combined with a PEEP of 10 cm H(2)O (T10).

RESULTS

All maneuvers increased the CSA of the right internal jugular vein with respect to the control condition S0 (all P < 0.05). S5 increased the CSA on average by 15.9%, S10 by 22.3%, T0 by 39.4%, T5 by 38.7%, and T10 by 49.7%.

CONCLUSION

In a comparison of the effectiveness of applying different PEEP levels and/or the Trendelenburg tilt position on the CSA of the right internal jugular vein, the Trendelenburg tilt position was most effective.

摘要

背景

增加右颈内静脉的横截面积（CSA）有助于导管插入并减少并发症。头高位倾斜和呼气末正压通气（PEEP）等操作可能会增加右颈内静脉的 CSA。我们确定了不同操作对 CSA 的影响。

方法

在 50 例麻醉后的心胸外科手术患者中，使用二维超声评估右颈内静脉的 CSA。首先，在无 PEEP 的仰卧位（对照条件 S0）下测量 CSA，并与 5 种不同的随机顺序操作进行比较：（1）PEEP 通气 5cmH₂O（S5），（2）PEEP 10cmH₂O（S10），（3）0cmH₂O PEEP 的 20 度头高位倾斜位（T0），（4）PEEP 5cmH₂O 的 20 度头高位倾斜位（T5），（5）PEEP 10cmH₂O 的 20 度头高位倾斜位（T10）。