经锁骨下路锁骨下动脉穿刺插管的应用解剖

Applied anatomy for subclavian artery puncture and cannula from subclavicular space

目的：为经锁骨下路锁骨下动脉穿刺插管提供解剖学基础。方法：对２４侧成人标本锁骨下动脉的走行、毗邻结构进行了解剖学观察，测量了经锁骨下路行锁骨下动脉和胸膜穿刺的角度和深度。结果：锁骨下动脉经过锁骨中点偏内约０．５ｃｍ处，或胸锁关节与喙突连线中点偏外１．５ｃｍ处。当在锁骨中外１／３下２．５ｃｍ处穿刺锁骨下动脉时额状面最佳角度为２３．３°±６．３°，横断面为１１．３°±５．３°，深度为４．１±０．８ｃｍ，与刺入胸膜顶有显著性差异。

Objective:To provide anatomical basis for subclavian artery (SCA) puncture and cannula.Methods:The course and syntopy of SCA were observed on 12 adult cadavers (24 sides).The angles and depths of the puncture needle inserted into SCA and cervical pleura were also measured.Results:The subclavian artery coursed 0.5 cm medially to the midpoint of clavicle or 1.5 cm laterally to the midpoint of line between the sternoclavicular joint and coracoid process. The puncture position was 2.5 cm below the external 1/3 of clavicle with the depth of 4.1±0.8 cm and the optimum angles of 23.3°±6.3° to coronal plane and 11.3°±5.3° to horizontal plane.There were significant differences between SCA and cupula pleuralis punctures in angles and depth. Conclusions:SCA puncture and cannula from subclavicular space is feasible and safe.