不同年龄患儿不同体位时股动脉与股静脉的解剖关系

Ultrasound imaging findings of anatomical relationship between femoral artery and vein in children of different ages

目的 研究不同年龄患儿不同体位时股动脉与股静脉的解剖关系。方法选取疝气修补术患儿，年龄4个月～7岁，ASA分级Ⅰ或Ⅱ级，按年龄分为婴儿组（≤1岁）、幼儿组（〉1岁，≤3岁）和学龄前儿童组（〉3岁，≤7岁）。取下肢伸直位和外展位，在腹股沟韧带处以及其下方2cm和4cm处扫描并采集超声图像，测量股动脉与股静脉夹角、股静脉未重叠宽度和股静脉深度。结果共有65例患儿完成本研究，婴儿组14例，幼儿组22例，学龄前儿童组29组。在腹股沟韧带处91％的患儿股静脉均位于股动脉内侧后方，到腹股沟韧带下方4cm处，股静脉均位于股动脉的后外侧方。3组下肢外展位时股静脉深度较伸直时减浅，学龄前儿童组下肢外展位时股静脉未重叠宽度增加（P〈0．05）；从腹股沟韧带至其下方4cm处股静脉深度逐渐增加，股静脉未重叠宽度逐步减小，股动脉与股静脉夹角均逐渐增大（P〈0．05），3组各测定指标比较差异无统计学意义（P〉0．05）。结论腹股沟韧带至其下方4cm处患儿股动脉与股静脉的解剖关系均为股静脉由股动脉内侧后方旋至外侧后方；下肢外展位时可减浅股静脉深度，在学龄前患儿中亦可增加股静脉未重叠宽度，提示患儿尤其是学龄前患儿股静脉穿刺时宜选择外展位。

Objective To investigate the ultrasound imaging findings of anatomical relationship between femoral artery and vein in children of different ages. Methods Sixty-five children aged 4 months-7 years were enrolled in this study. The children were divided into 3 age groups： group [ 〈 1 yr; group 1] 1-3 yr and group m 〉 3, ≤ 7 yr. A protable ultrasound machine was used. The probe was placed at the level of inguinal ligament and 2 and 4 cm below inguinal ligament. The children were placed in supine position. The legs were placed in 2 positions： （1） extended and in standard anatomical position and （2） flexed and 45°abducted and 45° laterally rotated. Results The examination showed that at the level of inguinal ligament, the femoral vein lay behind and lateral to femoral artery in 91% of children. At the level of 4 cm below inguinal ligament, the femoral vein lay posterior and lateral to the femoral artery in all children. When the leg was placed in abducted and laterally rotated, the depth of femoral vein was reduced and the vein was less overlapped by artery in all children, especially in preschool children. Conclusion At the level of 4 cm below inguinal ligament, the femoral vein lies posterior and lateral to the femoral artery in children. When the leg is placed in abducted and laterally rotated, the depth of femoral vein is reduced and the vein is less overlapped by artery. It is indicated that femoral vein puncture should be performed at the level of 4 cm below inguinal ligament with the leg flexed and abducted in all children, especially in preschool children.