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被动抬腿对肥胖患者右侧颈内静脉横截面积的影响:一项随机对照试验方案。

Effect of passive leg raising on the cross-sectional area of the right internal jugular vein in patients with obesity: a randomised controlled trial protocol.

机构信息

Tongren Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China

Tongren Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China.

出版信息

BMJ Open. 2024 May 6;14(5):e085044. doi: 10.1136/bmjopen-2024-085044.

DOI:10.1136/bmjopen-2024-085044
PMID:38719285
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11086179/
Abstract

BACKGROUND

Venous access in patients with obesity presents significant challenges. The success of central venous catheterisation largely depends on the cross-sectional area (CSA) of the internal jugular vein (IJV). While techniques like the Trendelenburg position have been traditionally used to increase IJV CSA, recent studies suggest its ineffectiveness in patients with obesity. Conversely, the potential of the effect of passive leg raising (PLR) has not been thoroughly investigated in this group of patients.

METHODS

This protocol outlines a planned randomised controlled trial to evaluate the effect of PLR on the CSA of the IJV in patients with obesity slated for central venous catheterisation. The protocol involves dividing 40 participants into two groups: one undergoing PLR and another serving as a control group without positional change. The protocol specifies measuring the CSA of the IJV via ultrasound as the primary outcome. Secondary outcomes will include the success rates of right IJV cannulation. The proposed statistical approach includes the use of t-tests to compare the changes in CSA between the two groups, with a significance threshold set at p<0.05.

ETHICS APPROVAL

This study has been approved by the Institutional Review Board of Shanghai Tongren Hospital. All the participants will provide informed consent prior to enrolment in the study. Regarding the dissemination of research findings, we plan to share the results through academic conferences and peer-reviewed publications. Additionally, we will communicate our findings to the public and professional communities, including patient advocacy groups.

TRIAL REGISTRATION NUMBER

ChiCTR: ChiCTR2400080513.

摘要

背景

肥胖患者的静脉通路建立存在显著挑战。中心静脉导管置管的成功率在很大程度上取决于颈内静脉(IJV)的横截面积(CSA)。虽然传统上采用头低位等技术来增加 IJV CSA,但最近的研究表明,这些技术在肥胖患者中效果不佳。相反,被动抬腿(PLR)对这组患者的影响潜力尚未得到充分研究。

方法

本方案概述了一项计划中的随机对照试验,旨在评估 PLR 对肥胖患者中心静脉导管置管时 IJV CSA 的影响。该方案将 40 名参与者分为两组:一组进行 PLR,另一组作为不改变体位的对照组。方案规定通过超声测量 IJV CSA 作为主要结局。次要结局将包括右侧 IJV 穿刺成功率。拟采用 t 检验比较两组 CSA 的变化,以 p<0.05 为显著性阈值。

伦理批准

本研究已获得上海交通大学附属同仁医院机构审查委员会的批准。所有参与者在入组前均将提供知情同意。关于研究结果的传播,我们计划通过学术会议和同行评审出版物分享研究结果。此外,我们将向公众和专业社区,包括患者权益组织,传达我们的发现。

临床试验注册号

ChiCTR:ChiCTR2400080513。

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本文引用的文献

1
Trendelenburg (Head-Down tilt) and head rotation: Ultrasonographic effects on the internal jugular vein for catheterization safety.特伦德伦伯格(头低位倾斜)和头部旋转:超声对颈内静脉置管安全的影响。
Clin Anat. 2022 Oct;35(7):883-890. doi: 10.1002/ca.23884. Epub 2022 Apr 19.
2
Comparison of the effect of different degrees of passive leg raising on the internal jugular vein cross-sectional area in patients before thoracic surgery.比较不同程度被动抬腿对胸外科术前患者颈内静脉横截面积的影响。
BMC Anesthesiol. 2019 May 17;19(1):78. doi: 10.1186/s12871-019-0751-5.
3
Prediction of fluid responsiveness in ventilated patients.机械通气患者液体反应性的预测
Ann Transl Med. 2018 Sep;6(18):352. doi: 10.21037/atm.2018.05.03.
4
Comparison of internal jugular vein dilation between Valsalva maneuver and proximal internal jugular vein compression.瓦尔萨尔瓦动作与颈内静脉近端压迫时颈内静脉扩张情况的比较。
Clin Exp Emerg Med. 2016 Dec 30;3(4):193-196. doi: 10.15441/ceem.15.098. eCollection 2016 Dec.
5
Effects of the Trendelenburg Position and Positive End-Expiratory Pressure on the Internal Jugular Vein Cross-Sectional Area in Children With Simple Congenital Heart Defects.头低脚高位和呼气末正压对单纯先天性心脏病患儿颈内静脉横截面积的影响
Medicine (Baltimore). 2016 May;95(18):e3525. doi: 10.1097/MD.0000000000003525.
6
Comparison of the effect of the Trendelenburg and passive leg raising positions on internal jugular vein size in critically ill patients.比较头低脚高位和被动抬腿体位对危重症患者颈内静脉大小的影响。
Int J Clin Exp Med. 2015 Oct 15;8(10):19037-43. eCollection 2015.
7
The effectiveness of trendelenburg positioning on the cross-sectional area of the right internal jugular vein in obese patients.特伦德伦伯格体位对肥胖患者右颈内静脉横截面积的影响。
Pak J Med Sci. 2015 Jul-Aug;31(4):770-4. doi: 10.12669/pjms.314.7326.
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Positive end-expiratory pressure to increase internal jugular vein size is poorly tolerated in obese anesthetized adults.在肥胖的麻醉成年患者中,通过呼气末正压来增加颈内静脉直径的耐受性较差。
Anesth Analg. 2014 Sep;119(3):619-621. doi: 10.1213/ANE.0000000000000347.
9
Thyrocervical artery - jugular fistula following internal jugular venous catheterization.颈内静脉置管后甲状腺颈干动脉-颈静脉瘘
Indian J Nephrol. 2014 May;24(3):178-80. doi: 10.4103/0971-4065.132019.
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The influence of laparoscopic vs. open gastric bypass on hemodynamic function in morbidly obese patients during general anesthesia.腹腔镜与开腹胃旁路手术对病态肥胖患者全身麻醉期间血流动力学功能的影响。
Wideochir Inne Tech Maloinwazyjne. 2014 Mar;9(1):83-8. doi: 10.5114/wiitm.2014.40988. Epub 2014 Feb 26.