Gok Funda, Sarkilar Gamze, Kilicaslan Alper, Yosunkaya Alper, Uzun Sema Tuncer
Department of Anaesthesiology and Critical Care, Meram Medical Faculty, Necmettin Erbakan University Konya, Turkey.
Int J Clin Exp Med. 2015 Oct 15;8(10):19037-43. eCollection 2015.
Central vein catheterization is a common procedure performed on patients under intensive care. The safe and successful placement of the central venous catheter depends on vein size. Although used for this purpose, the Trendelenburg position can be hazardous in some patients. The aim of this study was to compare the effects of the Trendelenburg and passive leg raising (PLR) positions on the size of the right internal jugular vein (IJV) in mechanically ventilated patients under intensive care. Seventy-eight mechanically ventilated patients under intensive care were included into the study. Sonographic images of the right IJV were recorded in supine (control), 10° Trendelenburg and 40° PLR positions. Anterior-posterior and transverse diameter, cross-sectional area (CSA), and depth were calculated from the recorded images. The size of the right IJV (CSA, transverse and vertical diameters) was significantly larger in the Trendelenburg and PLR positions than in supine position. An increase of 26% in the IJV CSA was obtained in the Trendelenburg position and 23% in the PLR position, compared to the supine position. There was no significant difference between the measurements obtained from the Trendelenburg and PLR positions. The study shows that the Trendelenburg and PLR positions increase the size of the IJV to a similar extent in mechanically ventilated patients under intensive care.
中心静脉置管是对重症监护患者实施的常见操作。中心静脉导管的安全且成功置入取决于静脉大小。尽管特伦德伦伯格体位用于此目的，但在某些患者中可能存在风险。本研究的目的是比较特伦德伦伯格体位和被动抬腿（PLR）体位对重症监护下机械通气患者右颈内静脉（IJV）大小的影响。78例重症监护下的机械通气患者纳入本研究。在仰卧位（对照）、10°特伦德伦伯格体位和40°PLR体位下记录右IJV的超声图像。根据记录的图像计算前后径和横径、横截面积（CSA）以及深度。特伦德伦伯格体位和PLR体位下右IJV的大小（CSA、横径和垂直径）明显大于仰卧位。与仰卧位相比，特伦德伦伯格体位下IJV的CSA增加了26%，PLR体位下增加了23%。特伦德伦伯格体位和PLR体位的测量结果之间无显著差异。研究表明，在重症监护下的机械通气患者中，特伦德伦伯格体位和PLR体位使IJV大小增加的程度相似。
