Ahn Jin Hee, Park Jiyeon, Song In Sun, Kim Keoung Ah, Park Jungchan, Min Jeong Jin, Kim Chung Su, Lee Jong-Hwan
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Paediatr Anaesth. 2019 Apr;29(4):361-367. doi: 10.1111/pan.13603. Epub 2019 Mar 21.
Since the femoral artery frequently overlaps the femoral vein, femoral central venous catheterization carries the risk of arterial puncture in pediatric patients.
We evaluated the angle range of leg abduction with external hip rotation to minimize the overlap between the femoral artery and vein in pediatric patients undergoing general anesthesia.
Eighty-two pediatric patients who underwent elective surgery with general anesthesia were enrolled in this study. Using ultrasonography, patients were divided into groups N (patients with non-overlap) and O (patients with continuing overlap) based on the presence of non-overlap range between the femoral artery and vein. The range minimizing the overlap was defined as the range without overlap in group N and as the range presenting the overlap that was less-than-half of the radius of the femoral vein in group O. By increasing the angle of leg abduction with external hip rotation, the starting and ending angles minimizing the overlap were found using ultrasonographic images.
The angle range of leg abduction with external hip rotation minimizing the overlap between the femoral artery and vein was defined as the range from the maximum 99% confidence interval of starting angles to the minimum 99% confidence interval of ending angles, which was between 45° and 65° in group N and between 48° and 58° in group O, respectively.
Positioning patients in a range of 48° and 58° leg abduction with external hip rotation can minimize the overlap between the femoral artery and vein. However, the clinical usefulness of this positioning for femoral venous catheterization remains to be seen.
由于股动脉常与股静脉重叠,小儿股静脉中心置管存在动脉穿刺风险。
我们评估了外旋髋关节时下肢外展的角度范围,以尽量减少接受全身麻醉的小儿患者股动脉与静脉的重叠。
82例接受择期全身麻醉手术的小儿患者纳入本研究。通过超声检查,根据股动脉与静脉之间是否存在无重叠范围,将患者分为N组(无重叠患者)和O组(持续重叠患者)。将使重叠最小化的范围定义为N组中无重叠的范围,以及O组中重叠小于股静脉半径一半的范围。通过增加外旋髋关节时下肢外展的角度,利用超声图像找到使重叠最小化的起始角度和结束角度。
外旋髋关节时下肢外展使股动脉与静脉重叠最小化的角度范围定义为从起始角度的最大99%置信区间到结束角度的最小99%置信区间,N组分别为45°至65°,O组为48°至58°。
将患者置于外旋髋关节、下肢外展48°至58°的范围内可使股动脉与静脉的重叠最小化。然而,这种定位对股静脉置管的临床实用性仍有待观察。