Yuan Kai-Ming, Liu En-Ci, Li Ping, Shangguan Wang-Ning, Li Jun, Lian Qing-Quan
Department of Anesthesiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
The first ward, the Eye Hospital of Wenzhou Medical University, Wenzhou, China.
Paediatr Anaesth. 2017 Oct;27(10):1003-1009. doi: 10.1111/pan.13211. Epub 2017 Jul 24.
Landmark-guided internal jugular vein cannulation is difficult for pediatric patients but useful, especially when ultrasound equipment is unavailable. Therefore, it is important to define the adjacent anatomic characteristics of the pediatric internal jugular vein.
In 210 children the course of the internal jugular vein, and common carotid and vertebral arteries was measured from the level of the cricoid cartilage to the supraclavicular area using ultrasound.
From the level of the cricoid cartilage to the supraclavicular area, vessel diameter increased with internal jugular vein increasing by 12%, and common carotid and vertebral arteries increasing by 5% each. From the level of the cricoid cartilage to the supraclavicular area, the number of patients with a medial common carotid artery position relative to the internal jugular vein increased, whereas those with a lateral position decreased; the number of patients with nonoverlapped common carotid artery-internal jugular vein increased, and those with totally overlapped decreased. In contrast, the overlapping status of vertebral artery-internal jugular vein changes oppositely. More than 97.14% of the vertebral artery lies lateral to the internal jugular vein at these levels. The minimal vertebral artery-internal jugular vein depth decreased from 0.46±0.20 to 0.37±0.19 cm. The angle from the internal jugular vein line to the horizontal line of the body was 83.35±9.04 degrees.
The common carotid artery and internal jugular vein are farther apart as one moves down the neck, whereas the vertebral artery and internal jugular vein are getting together. Additionally, the diameter of the internal jugular vein increased.
地标引导下的颈内静脉置管对儿科患者来说有难度，但很有用，尤其是在没有超声设备的情况下。因此，明确小儿颈内静脉的相邻解剖特征很重要。
对210名儿童使用超声测量从环状软骨水平至锁骨上区域的颈内静脉、颈总动脉和椎动脉的走行。
从环状软骨水平至锁骨上区域，血管直径增大，颈内静脉增大12%，颈总动脉和椎动脉各增大5%。从环状软骨水平至锁骨上区域，颈总动脉位于颈内静脉内侧的患者数量增加，而位于外侧的患者数量减少；颈总动脉与颈内静脉不重叠的患者数量增加，完全重叠的患者数量减少。相比之下，椎动脉与颈内静脉的重叠状态变化相反。在这些水平，超过97.14%的椎动脉位于颈内静脉外侧。椎动脉与颈内静脉的最小深度从0.46±0.20 cm降至0.37±0.19 cm。颈内静脉线与身体水平线的夹角为83.35±9.04度。
随着颈部向下移动，颈总动脉与颈内静脉距离变远，而椎动脉与颈内静脉距离变近。此外，颈内静脉直径增大。
