BACKGROUND In recent years, with the popularity of laryngeal mask airway(LMA) for the management of clinical anesthesia, the influence of the LMA on the position and blood flow of the internal jugular vein(IJV) has at...BACKGROUND In recent years, with the popularity of laryngeal mask airway(LMA) for the management of clinical anesthesia, the influence of the LMA on the position and blood flow of the internal jugular vein(IJV) has attracted an increasing amount of attention.AIM To investigate the effect of placement of different types of LMA(Supreme LMA,Guardian LMA, I-gel LMA) on the position and blood flow of the right IJV.METHODS This was a prospective randomized controlled trial. A total of 102 patients aged 18-75 years who were scheduled to undergo laparoscopic abdominal surgery with general anesthesia were randomly assigned to three groups: Supreme LMA(group 1), Guardian LMA(group 2), and I-gel LMA(group 3) groups. The main indicator was the overlap index(OI) of IJV and the common carotid artery(CCA)at the high, middle, and low points before and after the placement of the LMA.The second indicators were the proportion of ultrasound-simulated needle crossing the IJV and CCA, and the cross-sectional area and blood flow velocity of the IJV before and after placement of the LMA at the middle point.RESULTS Data from 100 patients were included in the statistical analysis. The OI increased significantly after placement of the LMA in the three groups at the three points(P< 0.01), except group 2 at the low point. In group 2 and group 3, the OI was lower than that in group 1 after LMA insertion at the high point(P < 0.0167). At the middle point, after LMA insertion, the proportion of simulated needle crossing the IJV significantly decreased in all three groups(P < 0.05), and the proportion in group 2 was higher than that in group 3(P < 0.0167). The proportion of simulated needle crossing the CCA or both the IJV and CCA significantly increased in group 1 and group 2(P < 0.05), which increased with no statistical significance in group 3. After LMA insertion, the cross-sectional area of the IJV significantly increased, while the blood flow velocity significantly decreased(P <0.01). There was no significant difference among the three groups.CONCLUSION The placement of Supreme, Guardian, and I-gel LMA can increase the OI, reduce the success rate of IJV puncture, increase the incidence of arterial puncture, and cause congestion of IJV. Type of LMA did not influence the difficulty of IJV puncture. Therefore when LMA is used, ultrasound is recommended to guide the IJV puncture.展开更多
目的探究超声血流参数[收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)、阻力指数(RI)]、D-二聚体手术前后变化及复合模型在创伤骨折患者下肢深静脉血栓形成(DVT)预警中的应用价值。方法选取2021年7月—2023年7月收治的创伤骨折200例,...目的探究超声血流参数[收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)、阻力指数(RI)]、D-二聚体手术前后变化及复合模型在创伤骨折患者下肢深静脉血栓形成(DVT)预警中的应用价值。方法选取2021年7月—2023年7月收治的创伤骨折200例,根据术后是否发生下肢DVT分为发生组25例与未发生组175例。收集2组基线资料及手术前后Vs、Vd、RI、D-二聚体数据,根据创伤骨折患者术后下肢DVT发生影响因素构建预测复合模型,评估Vs、Vd、RI、D-二聚体手术前后差值联合及复合模型对创伤骨折患者术后下肢DVT发生的预测价值。绘制决策曲线分析(DCA),分析超声血流参数、D-二聚体与复合模型预测创伤骨折患者术后下肢DVT发生的获益情况。结果发生组手术时间长于未发生组,术中使用止血带比例高于未发生组(P<0.01);发生组术后3 d Vs、Vd低于未发生组,RI、D-二聚体高于未发生组(P<0.01);发生组Vs、Vd、RI及D-二聚体手术前后差值均大于未发生组(P<0.01);多因素Logistic回归分析显示,手术时间、术中使用止血带及Vs、Vd、RI、D-二聚体手术前后差值为创伤骨折患者术后下肢DVT发生的独立危险因素(P<0.01);以Vs、Vd、RI、D-二聚体手术前后差值联合预测下肢DVT的曲线下面积(AUC)为0.882(95%CI:0.829,0.923),敏感度、特异度均为0.88。构建下肢DVT预测模型,其AUC为0.920(95%CI:0.873,0.954);DCA显示,复合模型在阈值概率为0.10~0.90时具有更高的临床价值。结论手术时间、术中使用止血带及Vs、Vd、RI、D-二聚体手术前后差值为创伤骨折患者术后下肢DVT发生的独立危险因素;与Vs、Vd、RI、D-二聚体手术前后差值相比,多指标联合建立的复合模型在创伤骨折术后下肢DVT早期预警中应用价值更高。展开更多
文摘BACKGROUND In recent years, with the popularity of laryngeal mask airway(LMA) for the management of clinical anesthesia, the influence of the LMA on the position and blood flow of the internal jugular vein(IJV) has attracted an increasing amount of attention.AIM To investigate the effect of placement of different types of LMA(Supreme LMA,Guardian LMA, I-gel LMA) on the position and blood flow of the right IJV.METHODS This was a prospective randomized controlled trial. A total of 102 patients aged 18-75 years who were scheduled to undergo laparoscopic abdominal surgery with general anesthesia were randomly assigned to three groups: Supreme LMA(group 1), Guardian LMA(group 2), and I-gel LMA(group 3) groups. The main indicator was the overlap index(OI) of IJV and the common carotid artery(CCA)at the high, middle, and low points before and after the placement of the LMA.The second indicators were the proportion of ultrasound-simulated needle crossing the IJV and CCA, and the cross-sectional area and blood flow velocity of the IJV before and after placement of the LMA at the middle point.RESULTS Data from 100 patients were included in the statistical analysis. The OI increased significantly after placement of the LMA in the three groups at the three points(P< 0.01), except group 2 at the low point. In group 2 and group 3, the OI was lower than that in group 1 after LMA insertion at the high point(P < 0.0167). At the middle point, after LMA insertion, the proportion of simulated needle crossing the IJV significantly decreased in all three groups(P < 0.05), and the proportion in group 2 was higher than that in group 3(P < 0.0167). The proportion of simulated needle crossing the CCA or both the IJV and CCA significantly increased in group 1 and group 2(P < 0.05), which increased with no statistical significance in group 3. After LMA insertion, the cross-sectional area of the IJV significantly increased, while the blood flow velocity significantly decreased(P <0.01). There was no significant difference among the three groups.CONCLUSION The placement of Supreme, Guardian, and I-gel LMA can increase the OI, reduce the success rate of IJV puncture, increase the incidence of arterial puncture, and cause congestion of IJV. Type of LMA did not influence the difficulty of IJV puncture. Therefore when LMA is used, ultrasound is recommended to guide the IJV puncture.
文摘目的探究超声血流参数[收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)、阻力指数(RI)]、D-二聚体手术前后变化及复合模型在创伤骨折患者下肢深静脉血栓形成(DVT)预警中的应用价值。方法选取2021年7月—2023年7月收治的创伤骨折200例,根据术后是否发生下肢DVT分为发生组25例与未发生组175例。收集2组基线资料及手术前后Vs、Vd、RI、D-二聚体数据,根据创伤骨折患者术后下肢DVT发生影响因素构建预测复合模型,评估Vs、Vd、RI、D-二聚体手术前后差值联合及复合模型对创伤骨折患者术后下肢DVT发生的预测价值。绘制决策曲线分析(DCA),分析超声血流参数、D-二聚体与复合模型预测创伤骨折患者术后下肢DVT发生的获益情况。结果发生组手术时间长于未发生组,术中使用止血带比例高于未发生组(P<0.01);发生组术后3 d Vs、Vd低于未发生组,RI、D-二聚体高于未发生组(P<0.01);发生组Vs、Vd、RI及D-二聚体手术前后差值均大于未发生组(P<0.01);多因素Logistic回归分析显示,手术时间、术中使用止血带及Vs、Vd、RI、D-二聚体手术前后差值为创伤骨折患者术后下肢DVT发生的独立危险因素(P<0.01);以Vs、Vd、RI、D-二聚体手术前后差值联合预测下肢DVT的曲线下面积(AUC)为0.882(95%CI:0.829,0.923),敏感度、特异度均为0.88。构建下肢DVT预测模型,其AUC为0.920(95%CI:0.873,0.954);DCA显示,复合模型在阈值概率为0.10~0.90时具有更高的临床价值。结论手术时间、术中使用止血带及Vs、Vd、RI、D-二聚体手术前后差值为创伤骨折患者术后下肢DVT发生的独立危险因素;与Vs、Vd、RI、D-二聚体手术前后差值相比,多指标联合建立的复合模型在创伤骨折术后下肢DVT早期预警中应用价值更高。
