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
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。
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.
呼气末正压通气 / 穿刺 / 置管术 / 颈内静脉 / 全身麻醉
Positive end expiratory pressure / Puncture / Catheterization / Internal jugular vein / General anesthesia
[1] Lim T, Ryu H G, Jung C W, et al. Effect of the bevel direction of puncture needle on success rate and complications during internal jugular vein catheterization[J]. Crit Care Med, 2012, 40(2):491-494.
[2] 王新文. 改良Trendelenburg体位对右颈内静脉穿刺置管成功率的影响[J]. 临床肾脏病杂志, 2014, 14(2):116-118.
[3] 杨中良，周竞崎，孙宝玲，等. 呼气末正压通气对重型颅脑损伤患者中心静脉压的影响[J]. 中国危重病急救医学, 2012, 24(5):283-285.
[4] Muralidhar K. Left internal versus right internal jugular vein access to central venous circulation using the Seldinger technique[J]. J Cardiothorac Vasc Anesth, 1995, 9(1):115-116.
[5] Berlin DA. Preventing complications of central venous catheterization[J]. N Engl J Med, 2003, 348(26):2684-2686.
[6] Perbet S, Pereira B, Grimaldi F, et al. Guidance and examination by ultrasound versus landmark and radiographic method for placement of subclavian central venous catheters: study protocol for a randomized controlled trial[J]. Trials, 2014, 8(15):175-182.
[7] 卜凡文，姜莉，贾卫国，等. 颈内静脉置管术超声导航的临床研究[J]. 疾病监测与控制, 2015, 9(1):19-21.
[8] Yang Y, Li Y, Liu SQ, et al. Positive end expiratory pressure titrated by transpulmonary pressure improved oxygenation and respiratory mechanics in acute respiratory distress syndrome patients with intra-abdominal hypertension[J]. Chin Med J (Engl), 2013, 126(17):3234-3239.
[9] 王海峰，刘笑雷，陶永康，等. PEEP 对机械通气患者中心静脉压、下腔静脉管径及呼吸变异率的影响[J]. 中国急救复苏与灾害医学杂志, 2012, 7(8):728-731.
[10] 周清河，严敏，肖旺频. 气道加压对全麻患者右颈内静脉穿刺置管术的影响[J]. 中华麻醉学杂志, 2010, 30(9):1130-1132.
[11] 王敬媛. 机械通气患者体位及呼气末正压对中心静脉压的影响[J]. 医学理论与实践, 2009, 22(6):627-628.
[12] 周清河. 不同气道正压对全麻患者右颈内静脉穿刺置管术的影响[D]. 浙江大学, 2011.
国家科技支撑计划（2011BAI11B22）
京ICP备08002354号-3/
| 〈 |
|
〉 |
