Zhang Yi-Long, Mi Wei-Dong, Yu De-Jiang, Fu Qiang, Feng Xue-Xin
Anesthesia and Operation Center, PLA General Hospital, Beijing 100853, China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2011 Oct;33(5):479-84.
To explore the clinical value of ultrasonic surface localization in internal jugular vein catheterization.
Totally 150 patients with American Society of Anesthesiologists physical status I -III who were planning to receive elective surgeries were randomized into anatomical landmark group, ultrasonic surface positioning group, and ultrasound-guided group using computed random table, with 50 cases in each group. The right internal jugular vein catheterization was performed after tracheal intubation. In the anatomic landmark group, patients were punctured using surface marks through central approach. In ultrasonic surface positioning group and ultrasound-guided group, patients were punctured with ultrasonic localization and guidance through central approach. The relationship between internal jugular vein and carotid artery, the position of the needle into the vein, the success rate of puncture, the change times of puncture point, and the complications were recorded.
Ultrasound scan revealed that the relationship between the right internal jugular vein and the right common carotid artery could be divided into three types: parallel (12.7%), partial overlapping (69.3%), and complete overlapping (18.0%). The average "safety distance" of jugular vein puncture was (1.15 +/- 0.47) cm. The success rate of the first puncture attempt in ultrasonic surface positioning group and ultrasound-guided group were 78.0% and 82.0%, respectively, which was significantly higher than that in anatomic landmark group (22.0%) (P < 0.05), whereas the complication incidence in anatomic landmark group (12.0%) were significantly higher than those in ultrasonic surface positioning group (0) and ultrasound-guided group (0) (P < 0.05).
Ultrasonic surface positioning applied during internal jugular vein catheterization is helpful to reveal the inner diameters as well as the origin and course of arteries and veins in the puncture and identify the abnormalities as early as possible. As a simple support technique for internal jugular vein puncture, it is suitable for clinical application.
探讨超声表面定位在内颈静脉置管中的临床价值。
将150例拟行择期手术的美国麻醉医师协会身体状况分级为I - III级的患者，采用计算机随机表法随机分为解剖标志组、超声表面定位组和超声引导组，每组50例。气管插管后行右侧颈内静脉置管。解剖标志组采用体表标志经中心入路穿刺；超声表面定位组和超声引导组采用超声定位和引导经中心入路穿刺。记录颈内静脉与颈动脉的关系、进针入静脉位置、穿刺成功率、穿刺点改变次数及并发症。
超声扫描显示，右侧颈内静脉与右侧颈总动脉的关系可分为三种类型：平行型（12.7%）、部分重叠型（69.3%）和完全重叠型（18.0%）。颈静脉穿刺的平均“安全距离”为（1.15±0.47）cm。超声表面定位组和超声引导组首次穿刺成功率分别为78.0%和82.0%，显著高于解剖标志组（22.0%）（P<0.05）；而解剖标志组并发症发生率（12.0%）显著高于超声表面定位组（0）和超声引导组（0）（P<0.05）。
颈内静脉置管时应用超声表面定位有助于在穿刺时显示动静脉内径及起源和走行，尽早发现异常。作为颈内静脉穿刺的一种简单辅助技术，适合临床应用。
