摘要
目的研究中国人颈内静脉和颈总动脉的解剖关系,以寻找颈内静脉穿刺最佳入路,提高穿刺成功率。方法选择需要中心静脉穿刺的择期手术患者280例,应用超声波扫描术测定甲状软骨上缘水平、环状软骨水平、第二气管环水平颈部3个平面双侧颈内静脉和颈总动脉的位置关系。结果自上而下,双侧颈内静脉横径逐渐增加,双侧颈总动脉横径逐渐减小(P<0.05),颈内静脉从颈总动脉外侧逐渐移向颈总动脉前面,即动静脉夹角逐渐变小,动脉重叠率和静脉重叠率均逐渐增加(P<0.01),静脉未重叠量逐渐减小(P<0.01)。同一扫描平面左右对比,右侧颈内静脉横径宽于左侧(P<0.01),双侧颈总动脉横径相似。在甲状软骨上缘和第二气管环水平,右侧动静脉夹角大于左侧(P<0.01),静脉重叠率小于左侧(P<0.01),3个扫描平面右侧静脉未重叠量均大于左侧(P<0.01)。280例患者中共有13例存在一个或多个扫描平面颈内静脉在颈总动脉内侧。在甲状软骨上缘水平,右侧颈总动脉有9例(3.2%)已分叉,左侧颈总动脉有16例(5.7%)已分叉。结论颈内静脉和颈总动脉的解剖位置存在较多变异。了解颈内静脉与颈总动脉的解剖关系有助于降低颈内静脉穿刺时误穿颈总动脉的发生率。
Objective To demonstrate the anatomic relationship of the internal jugular vein （IJV） and the common carotid artery （CCA） in order to identify the optimal puncture site and avoid inadvertent puncture of the CCA during central venous access. Methods Two hundred and eighty elective surgical patients requiring central venous access were includ-ed. The relationship between the IJV and the CCA at three cross sections （upper border of the thyroid cartilage, the ericoid cartilage and the second tracheal ring） were analyzed by uhrasonography. Results From up to down, the diameter of IJV became gradually larger and the diameter of CCA gradually smaller at both sides （P 〈 0.05）. The IJV was gradually moved from lateral to the CCA to the front of the CCA, so the angle between IJV and CCA became smaller （P 〈 0.01）. From up to down, the overlap between CCA and UV were gradually increased at both sides （P 〈 0.01） and the amount of unoverlap of IJV was gradually decreased （P 〈 0.01）. Compared with the left side at the same transverse scan level, the right IJV was wider and the amount of unoverlap of IJV was much wider on the right side （P 〈 0.01）. There were 13/280 patients whose IJV location were medial to the CCA at one or more transverse scan levels. CCA had already been furcated at the level of upper border of the thyroid cartilage in 9 patients （3.2%） at the right side and at the left side in 16 patients （5.7%）. Con-dusion There are variations in the relationship between the IJV and the CCA. Knowledge of the IJV anatomy and rela-tionship to the CCA is important for performing an IJV puncture, and this can potentially reduce the chance of CCA laceration.
出处
《北京医学》
CAS
2013年第8期657-660,共4页
Beijing Medical Journal
关键词
中心静脉穿刺
颈内静脉
颈总动脉
超声波扫描术
Central venous access
Internal jugular vein（IJV）
Common carotid artery（CCA）
Uhrasonography
