吹哨动作对颈内静脉穿刺置管患者颈内静脉横截面积及置管时间的影响

Influences of whistle behavior on the cross-sectional area of the internal jugular vein and catheterization time

目的：观察吹哨动作对颈内静脉横截面积及置管效果的影响。方法2014年7月—2015年8月浙江省宁波大学医学院附属鄞州人民医院ICU及手术室颈内静脉穿刺置管患者90例，采用随机数字表法将患者分为吹哨组（ B组）、Valsalva组（ V组）、对照组（ C组），各30例。所有患者依次做平静呼吸、吹哨动作、Valsalva动作，同时超声仪在右侧胸锁乳突肌三角顶点水平对颈内静脉横断面图像进行捕捉及测量；然后根据分组情况在指令动作下行超声引导下的颈内静脉穿刺置管并记录时间。结果平静呼吸、吹哨动作、Valsalva动作时颈内静脉横截面积分别为（101±28），（185±46），（196±59）mm2，差异均具有统计学意义（F＝5．716，P ＜0．05）；吹哨动作与 Valsalva 动作比较，差异无统计学意义（P ＞0．05）；B组、V组、C组穿刺置管时间分别为（123±26），（137±31），（174±46）s，三组比较差异有统计学意义（F＝3．618，P＜0．05），B组、V组与C组比较，差异均有统计学意义（P＜0．05）；B组与V组比较，差异无统计学意义（P＞0．05）。结论吹哨动作可以产生与Valsalva动作相同的颈内静脉扩张效果，缩短穿刺置管时间，简单易行。

Objective To investigate the influences of whistle behavior on the cross-sectional area of the internal jugular vein and catheterization .Methods The study investigated 90 patients who had internal jugular vein catheterization in ICU or the Operating Room of Yinzhou People′s Hospital of Ningbo University Medical College from July 2014 to August 2015 .The participants were divided into whistle group （ B group ） , Valsalva group （V group）, and the control group （C group） using random number table , with 30 participants in each group .All the participants did calm breathing , whistle , and Valsalva behavior in turn .Meanwhile , the images of internal jugular vein cross-section on the right sternocleidomastoid triangle apex level were captured and measured , and the catheterization time of internal jugular vein were recorded under ultrasound guidance . Results The cross-sectional area of the internal jugular vein were （101 ±28）, （185 ±46）, （196 ±59）mm2 when patients had calm breathing , whistling, and Valsalva behavior （F=5.716,P〈0.05）, but the differences of whistling and Valsalva behavior had no statistical significance （P 〉0.05）.The catheterization time of internal jugular vein for B, V, C group were （123 ±26）, （137 ±31）, and （174 ±46）s （F=3.618,P〈0.05）.The differences had statistical significance for B and V group compared with C group （P〈0.05）, but had no differences between B and V group （P〉0.05）.Conclusions The whistle and Valsalva behavior had similar effects on the dilatation of internal jugular vein and the reduction of catheterization time .