气道加压对全麻患者右颈内静脉穿刺置管术的影响

Effect of positive airway pressure on catheterization of right internal jugular vein in anesthetized patients

目的 探讨气道加压对全麻患者右颈内静脉穿刺置管术的影响.方法 需要进行右颈内静脉穿刺置管的全麻患者125例,随机分为对照组（C组,n=60）和气道加压组（P组,n=65）.超声引导下于环状软骨平面,C组在暂停机械通气时、P组手控呼吸维持气道压力20 cm H2O时进行右颈内静脉穿刺置管.暂停机械通气时测定两组右颈内静脉横截面积和穿刺成功后CVP,P组患者气道压力20 cm H2O时测定颈内静脉横截面积和CVP,记录穿刺次数、颈内静脉管壁至皮肤的最短距离、进针深度、进针和退出过程中回抽血液通畅情况,气道加压前测定HR和MAP,并记录气道加压过程中的最低值,观察两组患者的穿刺置管情况.结果 P组气道压力20 cm H2O时颈内静脉横截面积和CVP较气道加压前增加（P＜0.01）;与C组比较,P组进针深度降低,1次穿刺成功率、30 s内穿刺成功率、进针过程中回抽血液通畅率升高（P＜0.01）,心动过缓、低血压发生率升高（P＜0.05）.结论 气道加压有助于超声引导下右颈内静脉穿刺置管术的成功.

Objective To investigate the effect of positive airway pressure on catheterization of right internal jugular vein （IJV） in anesthetized patients. Methods One hundred and twenty-five ASA Ⅰ or Ⅱ patients aged 19-64 yr weighing 44-85 kg undergoing right IJV catheterization were randomly divided into 2 groups： control group （group C, n = 60） and positive airway pressure group （group P, n = 65）. Anesthesia was induced with midazolam, sufentanil and etomidate. Tracheal intubation was facilitated with vecuronium. The patients were mechanically ventilated. Right IJV was catheterized under the guidance of ultrasound and was punctured at the plane of cricoid cartilage. IJV catheterization was performed when mechanical ventilation was suspended in group C and when airway pressure was maintained at 20 cm H2O in group P. The cross section area of right IJV, CVP, the shortest dislance between right IJV and the skin and the depth of needle insertion were measured. The number of attempts to puncture the vein was calculated and the easiness of withdrawing blood from the right IJV after being pierced was assessed. MAP and HR were measured before and after positive airway pressure. Results Positive airway pressure （20 cm H2O） significantly increased the cross section area of IJV, CVP, success rates of puncturing IJV at first attempt and within 30 seconds and easiness of withdrawing blood from IJV after being pierced and deceased the depth of needle insertion as compared with control group. Positive airway pressure （20 cm H2O） also significantly increased the incidence of bradycardia and hypotension. Conclusion Positive airway pressure is helpful for right IJV catheterization guided by ultrasound under general anesthesia.