Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 Huaihai Rd. West, Shanghai, China.
Department of Industrial Engineering and Management, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China.
BMC Anesthesiol. 2019 May 17;19(1):78. doi: 10.1186/s12871-019-0751-5.
This study investigated the effect of different degrees of passive leg raising (PLR) on the internal jugular vein (IJV) cross-sectional area (CSA) and on the success rate of IJV cannulation in patients waiting for thoracic surgery, to analyze whether body mass index (BMI), gender, age, fasting time and preoperative rehydration have any impact on changes in the IJV CSA.
Eighty-two patients scheduled for selective thoracic surgery were enrolled in this study. Patients were randomly assigned based on a computer-generated randomization sequence into 3 groups: 0, 30, and 50 degrees (n = 32, 25, and 25 patients, respectively). The right IJV CSA in the sequence of 0-degree (supine position), 30-degree and 50-degree PLR positions was recorded in all patients using an ultrasound probe. The relationship of BMI, gender, age, fasting time and preoperative rehydration to the IJV CSA was analyzed. Then, each patient was returned to a supine position. After waiting for at least 5 min, patients were placed in a PLR position at 0, 30, or 50 degrees, and then IJV cannulation was performed without ultrasound guidance. The success rate of IJV catheterization at different PLR angles was compared.
The average CSA of the right IJV in the supine position, 30-degree PLR position and 50-degree PLR position was 1.39 ± 0.63 cm, 1.65 ± 0.73 cm, and 1.68 ± 0.71 cm, respectively. These results showed gradual increases in the IJV CSA of 18.5% (30-degree PLR) and 20.2% (50-degree PLR) when compared to that in the supine position (P = 0.045 and 0.025, respectively). However, only fasting time had a significant impact on the increase in the right IJV CSA at different PLR angles (P = 0.026). Other factors, such as BMI, gender, age and preoperative rehydration, had no significant effects. The success rates of IJV catheterization at angles of 0, 30 and 50 degrees were 84.3, 88 and 92%, respectively; however, there were no significant differences among the three groups (P = 0.674).
PLR increases the CSA of the right IJV, especially for patients with long fasting times before thoracic surgery. The effect of the 30-degree PLR position is similar to that of the 50-degree PLR position. However, the success rate of right IJV catheterization was not enhanced in this study using landmark-guided puncture, even though the CSA of the right IJV was increased.
Clinical trial registration number: ChiCTR1800015051 . Date of registration: March 2018.
本研究旨在探讨不同程度被动抬腿（PLR）对等待择期开胸手术患者的颈内静脉（IJV）横截面积（CSA）的影响，并分析体重指数（BMI）、性别、年龄、禁食时间和术前补液是否会影响 IJV CSA 的变化。
本研究纳入 82 例拟行择期开胸手术的患者。患者根据计算机生成的随机序列分为 3 组：0 度、30 度和 50 度（n=32、25 和 25 例）。所有患者均使用超声探头记录 0 度（仰卧位）、30 度和 50 度 PLR 位时右侧 IJV CSA。分析 BMI、性别、年龄、禁食时间和术前补液与 IJV CSA 的关系。然后，将每个患者放回仰卧位。等待至少 5min 后，患者置于 0、30 或 50 度 PLR 位，然后在无超声引导下进行 IJV 置管。比较不同 PLR 角度下 IJV 置管的成功率。
仰卧位、30 度 PLR 位和 50 度 PLR 位右侧 IJV CSA 分别为 1.39±0.63cm、1.65±0.73cm 和 1.68±0.71cm。与仰卧位相比，IJV CSA 分别增加了 18.5%（30 度 PLR）和 20.2%（50 度 PLR）（P=0.045 和 0.025）。然而，只有禁食时间对不同 PLR 角度下右侧 IJV CSA 的增加有显著影响（P=0.026）。其他因素，如 BMI、性别、年龄和术前补液，对右侧 IJV CSA 的增加没有显著影响。0、30 和 50 度角的 IJV 置管成功率分别为 84.3%、88%和 92%；然而，三组之间没有显著差异（P=0.674）。
PLR 增加了右侧 IJV 的 CSA，尤其是对于术前禁食时间较长的患者。30 度 PLR 位的效果与 50 度 PLR 位相似。然而，即使右侧 IJV CSA 增加，使用地标引导穿刺，右侧 IJV 置管的成功率也没有提高。
临床试验注册号：ChiCTR1800015051。注册日期：2018 年 3 月。
