不同型号喉罩对颈内静脉与颈总动脉解剖关系的影响

Influence of different types of laryngeal mask on relationship between the internal jugular vein and common carotid artery

目的探讨插入不同型号喉罩对颈内静脉与颈总动脉解剖关系的影响,选择插入喉罩后右侧颈内静脉最佳穿刺点。方法 46例喉罩通气择期手术的全麻患者,随机分为两组:3#喉罩组(n=22)和4#喉罩组(n=24)。观察并记录插入喉罩后即刻(T1)、插入喉罩后3min(T2)及拔出喉罩前(T3)的VT、PETCO2和气道峰压;记录颈部前路、中路及后路三个穿刺点喉罩插入前后颈总动脉直径(A)、颈总动脉与颈内静脉重叠距离(B),并计算颈总动脉和颈内静脉的重叠覆盖率(OI)。结果不同时点两组患者VT、PETCO2和气道峰压差异均无统计学意义。与喉罩插入前比较,插入后3#喉罩组前路、中路和后路A差异无统计学意义;插入后前路、中路和后路两组B明显扩大、OI明显增加(P<0.05),后路4#喉罩组A、B明显扩大、OI明显增加(P<0.05)。与4#喉罩组比较,喉罩插入后前路3#喉罩组B明显缩小(P<0.05),中路和后路3#喉罩组B明显缩小,OI明显减少(P<0.05)。无一例患者发生气胸等不良反应。结论成年全麻患者喉罩通气下行右侧颈内静脉穿刺,选择3#喉罩对颈内静脉和颈总动脉解剖关系影响小,而且对后路无影响,在无超声引导下,选择后路行颈内静脉穿刺,提高成功率,减少并发症。

Objective To observe the influence of two types of laryngeal mask on the anatomical location of the internal jugular vein （IJV） and common carotid artery（CCA）,so that to determine the optimal puncture site in the case of puncturing the right IJV after laryngeal mask placement.Methods Forty-six cases undergoing elective surgery with general anesthesia,using laryngeal mask airway were randomly divided into two groups,size 3 laryngeal mask group （group 3） or size 4 laryngeal group （group 4）.VT,PETCO2 and Ppeak was recorded at intubating laryngeal（T1）,3min after laryngeal insertion（T2）,and before laryngeal extubation （T3）.The diameter of CCA and overlapping distance was observed at three puncture points,including anterior（edge of the thyroid cartilage level,carotid lateral 0.5 cm）,middle （sternocleidomastoid triangle vertex level） and posterior （sternocleidomastoid lateral margin of the lower 1/3 of the intersection point,about two cross-refers to the supraclavicular） in all patients before and after laryngeal mask of carotid artery diameter,and the two overlapping rate （OI） was calculated.Results Group 3,the degree of overlapping of the right IJV and CCA was higher after laryngeal insertion at all three points,and the degree of overlapping was the highest in the middle; Group 4,the diameter of CCA and degree of overlapping of the right IJV and CCA after laryngeal mask was higher at all puncture points; After laryngeal mask placement,the degree of overlapping of the right IJV and CCA was higher in group 4 as compared with group 3 in all points （P＜ 0.05）,and OI in group 4 was higher in middle and posterior points（P＜0.05）.Conclusion Adult patients with general anesthesia,a size 3 laryngeal mask produced smaller influence on the anatomical location of the right IJV and CCA,especially rare on the posterior.In the absence of ultrasound,posterior puncture point was preferred,which can greatly improve the success rate and reduce complications.