特伦德伦伯格体位与上肢止血带对颈内静脉直径影响的比较。
Comparison of the Trendelenburg position versus upper-limb tourniquet on internal jugular vein diameter.
作者信息
Karaaslan Pelin, Gokay Banu Vural, Karakaya Muhammet Ahmet, Darcin Kamil, Karakaya Afak Durur, Ormeci Tugrul, Kose Emine Arzu
机构信息
Dr. Pelin Karaaslan, Department of Anesthesiology and Reanimation,, Istanbul Medipol University,, TEM Avrupa Otoyolu Goztepe, Cikisi No: 1,, Bagcilar, Istanbul 34078,, Turkey, T: +902127607831,
出版信息
Ann Saudi Med. 2017 Jul-Aug;37(4):308-312. doi: 10.5144/0256-4947.2017.308.
BACKGROUND
Central venous cannulation is a necessary invasive procedure for fluid management, haemodynamic monitoring and vasoactive drug therapy. The right internal jugular vein (RIJV) is the preferred site. Enlargement of the jugular vein area facilitates catheterization and reduces complication rates. Common methods to enlarge the RIJV cross-sectional area are the Trendelenburg position and the Valsalva maneuver.
OBJECTIVE
Compare the Trendelenburg position with upper-extremity venous return blockage using the tourniquet technique.
DESIGN
Prospective clinical study.
SETTING
University hospital.
SUBJECTS AND METHODS
Healthy adult volunteers (American Society of Anesthesiologists class I) aged 18-45 years were included in the study. The first measurement was made when the volunteers were in the supine position. The RIJV diameter and cross-sectional area were measured from the apex of the triangle formed by the clavicle and the two ends of the sternocleidomastoid muscle, which is used for the conventional approach. The second measurement was performed in a 20° Trendelenburg position. After the drainage of the veins using an Esbach bandage both arms were cuffed. The third measurement was made when tourniquets were inflated.
MAIN OUTCOME MEASURE(S): Hemodynamic measurements and RIJV dimensions.
RESULTS
In 65 volunteers the diameter and cross-sectional area of the RIJV were significantly widened in both Trendelenburg and tourniquet measurements compared with the supine position (P < .001 for both measures). Measurements using the upper extremity tourniquet were significantly larger than Trendelenburg measurements (P=.002 and < .001 for cross-sectional area and diameter, respectively).
CONCLUSION
Channelling of the upper-extremity venous return to the jugular vein was significantly superior when compared with the Trendelenburg position and the supine position.
LIMITATIONS
No catheterization and study limited to healthy volunteers.
背景
中心静脉置管是液体管理、血流动力学监测和血管活性药物治疗所必需的侵入性操作。右侧颈内静脉（RIJV）是首选部位。颈静脉区域扩大有助于置管并降低并发症发生率。扩大RIJV横截面积的常用方法是头低脚高位和瓦尔萨尔瓦动作。
目的
比较头低脚高位与使用止血带技术阻断上肢静脉回流的效果。
设计
前瞻性临床研究。
地点
大学医院。
对象与方法
纳入年龄在18 - 45岁的健康成年志愿者（美国麻醉医师协会I级）。首次测量在志愿者仰卧位时进行。从锁骨与胸锁乳突肌两端形成的三角形顶点测量RIJV直径和横截面积，此为传统进针部位。第二次测量在头低脚高位20°时进行。用埃斯巴赫绷带排空静脉后，双臂扎上袖带。第三次测量在止血带充气时进行。
主要观察指标
血流动力学测量和RIJV尺寸。
结果
65名志愿者中，与仰卧位相比，头低脚高位和使用止血带测量时RIJV的直径和横截面积均显著增宽（两项测量P均<0.001）。使用上肢止血带的测量值显著大于头低脚高位测量值（横截面积和直径的P值分别为0.002和<0.001）。
结论
与头低脚高位和仰卧位相比，将上肢静脉回流引导至颈静脉的效果显著更优。
局限性
未进行置管操作且研究仅限于健康志愿者。
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