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两种Veress针及四个穿刺部位对Veress针穿刺深度的影响:在犬尸体上的比较研究

Influence of 2 Veress needles and 4 insertion sites on Veress needle penetration depth: A comparative study in cadaveric dogs.

作者信息

Leschnik Katharina, Bockstahler Barbara, Katic Nikola, Schramel Johannes P, Dupré Gilles

机构信息

University Clinic of Small Animal Surgery, Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria.

Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria.

出版信息

Vet Surg. 2018 Nov;47(8):1094-1100. doi: 10.1111/vsu.12956. Epub 2018 Sep 23.

Abstract

OBJECTIVE

To evaluate the penetration depth (VNPD) of 2 disposable Veress needles (VN) at 4 insertion sites in the abdomen.

STUDY DESIGN

Descriptive study.

SAMPLE POPULATION

Canine cadavers (n = 22, 6 for confirmation of the test methods and 16 for the comparative study).

METHODS

Two disposable VN (VN A and VN B) were inserted at 4 sites (9th intercostal space [ICS] and preumbilical, paraumbilical, and subumbilical sites) in dorsally recumbent dogs by using a hand-cranked jig. The VNPD was measured as the distance traveled by the VN between the subcutaneous tissue and the perforation of the peritoneum on the basis of audible clicks and visible feedback from the VN. The effects of the VN type and insertion site on the VNPD were analyzed by using a linear mixed-effects model.

RESULTS

VNPD varied between insertion sites (P =  .01) and VN (P < .01). The VNPD was less at the 9th ICS than at the preumbilical, paraumbilical, and subumbilical sites. The maximal magnitude of change was 7.4 mm. Veress needle B (with a low spring rate, lower forces, and a back-cut bevel design) penetrated farther than VN A (with a high spring rate, high forces, and a lancet-type bevel) at 3 of 4 insertion sites. The maximal magnitude of change was 6.8 mm.

CONCLUSION

Veress needle penetration depth varied between VN designs but was the least at the 9th ICS in canine cadavers.

CLINICAL SIGNIFICANCE

Insertion of a VN at the 9th ICS is recommended to minimize its penetration into the abdomen. Associations between VNPD and mechanical factors, such as the sharpness and spring rate of VN, warrant additional research.

摘要

目的

评估2种一次性Veress针在腹部4个穿刺部位的穿刺深度(Veress针穿刺深度,VNPD)。

研究设计

描述性研究。

样本

犬类尸体(n = 22,6只用于验证测试方法,16只用于比较研究)。

方法

通过手摇夹具,将2种一次性Veress针(Veress针A和Veress针B)插入仰卧位犬的4个部位(第9肋间间隙[ICS]以及脐前、脐旁和脐下部位)。根据Veress针发出的可听咔哒声和可见反馈,将VNPD测量为Veress针在皮下组织与腹膜穿孔之间行进的距离。使用线性混合效应模型分析Veress针类型和穿刺部位对VNPD的影响。

结果

VNPD在穿刺部位之间(P = 0.01)和Veress针之间(P < 0.01)存在差异。第9肋间间隙的VNPD小于脐前、脐旁和脐下部位。最大变化幅度为7.4毫米。在4个穿刺部位中的3个部位,Veress针B(弹簧率低、力量较小且为反切斜面设计)比Veress针A(弹簧率高、力量大且为柳叶刀型斜面)穿刺得更深。最大变化幅度为6.8毫米。

结论

Veress针的穿刺深度在不同Veress针设计之间有所不同,但在犬类尸体的第9肋间间隙最小。

临床意义

建议在第9肋间间隙插入Veress针,以尽量减少其进入腹腔的深度。VNPD与机械因素(如Veress针的尖锐度和弹簧率)之间的关联值得进一步研究。

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