超声引导颈内静脉穿刺置管术在I-gel喉罩通气时的应用

Application of ultrasound-guided internal jugular vein cannulation in patient with laryngeal mask airway placement

目的探讨喉罩通气时行颈内静脉穿刺置管时超声引导法与传统体表标志定位方法的差异。方法将40例全身麻醉置入I-gel喉罩通气拟行平卧位腹部手术的成年患者随机分为超声引导组(U组,20例)与传统体表标志定位方法组(C组,20例),U组在超声实时引导下行颈内静脉置管术,C组使用传统的体表标志定位法行颈内静脉置管术。两组穿刺点均选择甲状软骨水平入路。记录U组患者喉罩置入前后甲状软骨水平颈内静脉与颈总动脉各自中心点的体表投射点与正中线间距离等变化。记录两组首次穿刺成功率、试穿次数、总成功率、穿刺时间及并发症情况。结果 U组患者喉罩置入前后颈内静脉与颈总动脉各自中心点与正中线距离均明显增加(P<0.01),颈内静脉内径、两者间水平距离、两者水平重叠率差异有统计学意义(P<0.01)。两组首次穿刺成功率、试穿次数、总成功率、穿刺时间及并发症差异均有统计学意义(P<0.01)。结论 I-gel喉罩置入会导致颈部血管外移,右颈内静脉内径及其与颈总动脉的水平距离及重叠率显著变化,不利于颈内静脉穿刺置管;喉罩通气中颈内静脉穿刺置管时超声引导法相对于传统体表标志定位方法可明显提高穿刺成功率。

Objective To compare the differences between the ultrasound guided and the conventional ana-tomical landmark method in internal jugular vein cannulation.Methods Forty adult patients undergoing elective sur-gery for abdominal operation were randomized into two groups.In the ultrasound group（group U）,the patients＇internal jugular vein cannulation was guided using an ultrasound imaging.In the landmark group（group C）,cannulation was used the method with the conventional anatomical landmark.Diameters of the internal jugular vein and the common ca-rotid artery,and the overlap between the IJV and CCA were measured before and after the LMA placement.The one puncture success rate,failure rate ,time and complications （the incidence of puncturing into artery,haematoma,hae-mothorax）were compared between two groups.Results Significant difference were observed in the diameter of the internal jugular vein and the overlap between the IJV and CCA after the LMA placement.The one puncture success rate,failure rate,time and complications were also significantly different between the two groups.Conclusion After the LMA placement the diameter of the IJV and the overlap between the IJV and CCA were significantly different, which may make it difficult to the cannulation.Ultrasound -guided IJV cannulation in patient with LMA placement is a higher accuracy method with more successful rate,less operation times and duration and less complications.