使用经食管超声获得右颈内静脉置管深度的经验公式

Prediction formula of appropriate depth of right internal jugular vein catheterization achieved by transesophageal echocardiography

目的使用经食管超声心动图(TEE)技术确定经中路右颈内静脉置管的最佳深度,结合体表标志测量和身高得出预测公式。方法选择具有术中使用TEE及中心静脉置管指征的患者74例,采用Seldinger.s技术进行经中路右颈内静脉置管。TEE观察导丝尖端位于上腔静脉中下段且心包反折外,测量此时导丝置入深度作为导管的固定深度。测量体表标志,并得出导管合适深度的经验公式。结果 TEE下经中路右颈内静脉置管的固定深度为(15.1±1.7)cm。建立固定深度的预测公式为:固定深度=身高÷20+(穿刺点经右胸锁关节到胸骨角右缘的连线距离)÷2(r=0.595,r^2=0.354,P <0.01)。结论根据TEE确定的最佳置管深度,结合身高和体表标志可以得出以上预测公式,为今后临床预测右颈内静脉置管的合适深度提供参考。

Objective To investigate the appropriate depth of the right internal jugular venous(RIJV) catheterization via middle approach determined by transesophageal echocardiography( TEE) and to generate a prediction formula for future RIJV catheterization. Methods Seventy four patients indicated for intraoperative TEE and central line placement were enrolled. After the intubation,right internal jugular venous catheterization via the middle approach was performed using Seldinger s method. When the J tip of the guide wire appeared at the junction of the superior vena cava and the right atrium under TEE guidance,the guide wire was pulled 2 ~ 3 cm backward until the tip of the guide wire was out of the pericardial fold,and this depth was regarded as the appropriate depth of the central venous catheter. Body landmark distance was measured and the prediction formula was generated. Results The central line depth under TEE guidance was(15.1 ± 1.7) cm. The prediction formula was:Central venous catheterization depth = Height ÷ 20 +(distance from the entry point to the sternal angle via the right sternoclavicular joint)÷ 2(r = 0.595,r^2 = 0.354,P<0.01). Conclusion TEE is an effective method to determine the appropriate depth of right internal jugular venous catheter. The prediction formula can be used as a reference for future RIJV catheterization via the middle approach.