颈内静脉的解剖与穿刺改良法的临床应用

Anatomy of internal jugular vein and clinical application of modified puncture

目的 探讨颈内静脉穿刺的最佳进路法 ,提高颈内静脉穿刺的成功率和减少并发症。方法 观察 42具成人尸体的颈内静脉外径及体表投影 ,颈内静脉与颈总动脉、胸锁乳突肌的关系 ,以胸锁乳突肌三角顶点上方 30mm处为穿刺点临床应用 16 9例 (改良法 ) ,并与中路法 15 0例作对比 ,观察两组的穿刺效果。结果 试验组穿刺成功率为97 6 % ,对照组为 95 .3 % (P <0 .0 5 )。试验组皮肤至颈内静脉的深度为 ( 2 1± 0 3)mm ,对照组为 ( 3 1± 0 3)mm(P <0 0 1)。试验组误穿动脉及胸膜发生率为 0 6 % ,对照组为 4.0 % (P <0 .0 1)。结论 颈内静脉穿刺改良法与中路法比较 ,进针浅 ,损伤小 ,安全性大。

Objective To explore the best approach of internal jugular vein puncture for improving the success rate of puncture and lessening the complications from puncture. Methods The internal jugular veins of 42 adult corpses were anatomized with their external conjugate diameters measured and body surface prejections marked. The relationship among internal jugular vein, common carotid, and sternocleidomastoid muscle was studied. The puncture point of modified puncture of internal jugular vein was chosen of 3 cm above the triangle top of sternocleidomastoid muscle. Results The success rate of puncture was 97.6% in test group (modified puncture) and 95.3% in control group (middle-approach puncture), with significant difference ( P <0 05). The depth from body surface to internal jugular vein was (2.1±0.3)cm in test group and (3.1±0.3) cm in control group( P <0 01). The incidence of accidental puncture of artery or pleura was 1/169 in test group and 6/150 in control group( P <0.01).Conclusion Compared with middle-approach puncture, modified puncture is safer and with less injury.