不同喉罩对右颈内静脉穿刺点的影响

Different Type Laryngeal Mask Impact on Right Internal Jugular Vein Puncture Point

观察三种常用喉罩置入后对右颈内静脉解剖位置及其本身的影响,选择最佳的穿刺位置。90例患者随机分为:Proseal组(P组,n=30)和Supreme组(S组,n=30)和SLIPA组(A组,n=30),使用多普勒超声在低位(锁骨上窝2cm水平)、中位(胸锁乳突肌三角顶点水平)及高位(胸锁乳突肌前缘中点),观察喉罩置入前后颈内静脉前后直径、横截面积、同颈总动脉间距离及二者重叠率的变化。结果在低位穿刺点三组喉罩置入前后各指标组内及组间比较均无显著性意义(P>0.01);在中位穿刺点喉罩置入前后A组各指标差异组内比较无显著性意义(P>0.01),S组和P组患者的各指标差异组内及组间比较均有显著性意义(P<0.01);在高位穿刺点三组患者喉罩置入前后各指标差异组内比较有显著性意义(P<0.01)。使用三种喉罩时,对低位右颈内静脉解剖特点及位置无影响,可作为使用喉罩时右颈内静脉穿刺首选解剖位置。

This study explore the impact of jugular vein anatomical position by three kinds of laryngeal mask insertion. To find the best method of internal jugular venipuncture,we studied 90 patients undergoing general anesthesia. Divide these patients into 3 groups randomly, each group has 30 patients. Proseal team（team P, n= 30 ） Supreme team （team S, n= 30 ） SLIPA team（team A, n= 30）Test the 3 anatomical positions changes before and after laryngeal insertion by Doppler ultra- sonography. The 3 positions are 2cm above supraclavicular fossa, Peak of sternocleidomastoid triangle, middle of sterno- cleidomastoid frontier. Record the data of anterior-posterior dimension, cross-sectional area of jugular vein, and the distance between the common carotid artery and jugular vein before and after laryngeal mask insertion, the rate of the two vessels＇ overlapping coefficient rate. Compare the data above of the three teams. There are no statistical differences before and af- ter laryngeal mask insertion at low puncture point in 3 groups. At middle puncture point,in team A, there is no difference before and after laryngeal mask insertion. In team S and team P, there are remarkable differences before and after laryngeal mask insertion. At puncture point high, all the patients has remarkable difference before and after laryngeal mask insertion （P〈0.01）. Proseal,Supreme and SLIPA laryngeal mask do not change the anatomical positions of low puncture point. Low puncture point is the best position of internal right jugular venipuncture when laryngeal mask insertion.