颈内静脉的局部应用解剖及两种穿刺入路的比较

Regional Anatomy of Internal Jugular Vein for Application and Comparison of Two Veinpuncture Ways

目的:观测尸体右颈内静脉局部解剖,比较改良穿刺法同传统入路法穿刺成功率和并发症的差异,为临床医生顺利进行颈内静脉置管提供参考。方法:对26具尸体进行解剖学观测颈内静脉的外径及体表投影,颈内静脉与颈总动脉和胸锁乳突肌的关系,为不同的穿刺入路提供解剖学依据。并选择215例行颈内静脉穿刺置管的患者,随机分成2组,实验组(改良颈总动脉旁穿刺法)和对照组(前路法),比较两组一次穿刺成功率、最终穿刺成功率、置管时间的差异;同时记录误入动脉、血胸、气胸等并发症的发生率。结果:实验组和对照组一次性穿刺成功率分别为83.6%和67.6%(P<0.01),最终穿刺成功率为97.3%和89.5%(P<0.05)。置管时间分别是(2.16±0.31)min和(3.00±0.39)min(P<0.01)。误穿动脉数分别是2例和10例(P<0.05)。结论:通过局部解剖学观测和临床实验比较,改良颈总动脉旁穿刺法比传统的前路法更安全和快捷。

Objective：To survey the regional anatomy of internal jugular vein of corpses and compare the achievement ratio and incidence of complications of two puncture ways,and to give suggestions for catheterization of the internal jugular vein in clinic.Methods：The external diameter and projection of body surface of internal jugular vein were surveyed,the relationship of internal jugular vein and carotid or stemocleidomastoid was compared.The bases for different ways of puncture were provided.215 patients undergoing elective catheterization of the internal jugular vein were randomly allocated into 2 groups：test group and control group.The difference of achievement ratio of veinpuncture was compared, the time of successful insertion and the associated complications were calculated.Results：The achievement ratios of veinpuncture for first time were 83.6% and 67.6%（P〈0.01）.The achievement ratios of veinpuncture at last were 97.3% and 89.5%（P〈0.05）.The time of insertion were（2.16±0.31）min and（3.00±0.39）min（P〈0.01）.The number of arterpuncture of two groups were 2 and 10（P〈0.05）.Conclusions：By surveying the regional anatomy of internal jugular vein and clinical test,the improved way is more easier and quicker than the antero-path way.