呼气末正压通气对全麻患者颈内静脉横截面积及穿刺置管术的影响

doi:10.13418/j.issn.1001-165x.2015.05.026

中国临床解剖学杂志 ›› 2015, Vol. 33 ›› Issue (5): 601-603.doi: 10.13418/j.issn.1001-165x.2015.05.026

呼气末正压通气对全麻患者颈内静脉横截面积及穿刺置管术的影响

郭远波¹ ,　王研²,　雷迁³,　徐金东¹ ,　王晟³

1.广东省人民医院广东省医学科学院麻醉科，广州 510080； 2.谢菲尔德大学健康与相关研究学院，英国 S10 2TN ；
3.广东省心血管病研究所麻醉科，广州 510080

收稿日期:2015-05-10 出版日期:2015-09-25 发布日期:2015-10-13
通讯作者: 王晟,男,主任医师,E-mail:shengwang_gz@163.com
作者简介:郭远波（1982-），山东临沂人，硕士，住院医师，主要从事临床麻醉研究，Email:xixia1313@163.com
基金资助:
国家科技支撑计划（2011BAI11B22）

The effects of positive end expiratory pressureon the cross-sectional areas, and puncture and catheterization of right internal jugular vein during general anesthesia

GUO Yuan-bo¹, WANG Yan², LEI Qian³, XU Jin-dong¹, WANG Sheng³

1. Department of Anesthesiology,Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080,China; 2.Health and Related Research Institute, the University of Sheffield,S10 2TN,United Kingdom; 3. Department of Anesthesiology,Guangdong Cardiovascular Institute,Guangzhou 510080,China

Received:2015-05-10 Online:2015-09-25 Published:2015-10-13

摘要/Abstract

摘要：

目的　探讨不同水平呼气末正压通气（PEEP）对全麻患者颈内静脉横截面积及穿刺置管术的影响。方法　304例择期心脏手术患者数字表法随机分为A组（PEEP=0 cmH2O）、B组（PEEP=5 cmH2O）、C组（PEEP=10 cmH2O）、D组（PEEP=15 cmH2O）。超声测量颈内静脉横截面；记录误穿动脉例数、进针回抽血液通畅情况、血肿形成及穿刺失败例数、心动过缓及低血压情况。结果　C、D组PEEP后颈内静脉的横截面积均较PEEP前明显增加（P<0.05）。PEEP后，C组与D组横截面积较其A组与B组明显提高（P<0.05）。C组及D组一次性穿刺成功率明显高于A组及B组（P<0.05）；在误穿动脉、局部血肿形成及穿刺失败方面，C组与D组均明显低于A组与B组（P<0.05）；在心动过缓及低血压次数上，D组明显高于其他各组（P<0.05）。结论　适当的PEEP可以明显增加颈内静脉横截面积，提高穿刺成功率，减少并发症。

关键词: 呼气末正压通气, 穿刺, 置管术, 颈内静脉, 全身麻醉

Abstract:

Objectivve　To investigate the effects of different degrees of positive end expiratory pressure (PEEP) on the cross-sectional areas (CSAs) and puncture and catheterization of right internal jugular vein (RIJV) in anesthetized patients.　Methods 　A total of 304 patients with selective cardiac operation were divided into four groups by random number table method: group A (PEEP=0 cmH2O), group B (PEEP=5 cmH2O), group C (PEEP=10 cmH2O), group D(PEEP=15 cm H2O). The CSAs of RIJV were measured by ultrasonography. Total puncture times, inadvertent carotid puncture times, easiness of withdrawing blood, cases of hematoma formation, cases of RIJV puncture failure were recorded. Bradycadia and hypotension were recorded．Results　CSAs of RIJV after PEEP in group C and group D were both significantly increased compared to that before PEEP (P<0.05); The CSAs of RIJV in group C and group D after PEEP were significantly larger than that of both group A and group B (P<0.05). The success rates of RIJV puncture at first attempt in group C and group D were significantly higher than that of both group A and group B (P<0.05). The incidence of inadvertent carotid puncture, local hematoma formation and puncture failure in group C and group D after PEEP were significantly lower than that of both group A and group B (P<0.05). The incidence of bradycardia and hypotension in group D were significantly higher than that of the other three groups (P<0.05).　Conclusions　Appropriate PEEP significantly increases the CSA of RIJV, increases the success rate of puncture, and decreases the incidence ofcomplications.

Key words: Positive end expiratory pressure, Puncture, Catheterization, Internal jugular vein, General anesthesia

郭远波,王研,雷迁,徐金东,王晟. 呼气末正压通气对全麻患者颈内静脉横截面积及穿刺置管术的影响[J]. 中国临床解剖学杂志, 2015, 33(5): 601-603.

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呼气末正压通气对全麻患者颈内静脉横截面积及穿刺置管术的影响

The effects of positive end expiratory pressureon the cross-sectional areas, and puncture and catheterization of right internal jugular vein during general anesthesia

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