雷兴阳+郭继东+祝兵

[摘要] 目的 探讨基于全麻下经胸锁乳突肌三角中路与颈动脉旁前路行右颈内静脉穿刺术的临床效果。 方法 随机选取2004年9月～2014年9月本院收治的全身麻醉患者100例，均行基于全麻下右颈内静脉穿刺置管术，分为经颈动脉旁前路穿刺置管组50例，经胸锁乳突肌三角中路穿刺置管组50例，对比分析两组患者的成功率和不良反应发生率。 结果 经颈动脉旁前路穿刺置管组成功48例（96%），失败2例（4%），经胸锁乳突肌三角中路穿刺置管组成功40例（80%），失败10例（20%），差异有统计学意义（P<0.05）；误穿动脉2例（4%），明显少于经胸锁乳突肌三角中路穿刺置管组12例（24%），差异有统计学意义（P<0.05）。 结论 基于全麻下右颈内静脉穿刺置管术，经颈动脉旁前路置管的效果更为显著，安全性更高，值得临床推广应用。

[关键词] 全身麻醉；右颈内静脉置管术；临床效果；颈动脉；胸锁乳突肌三角

[中图分类号] R614.2+4 [文献标识码] A [文章编号] 1674-4721（2015）07（b）-0096-03

[Abstract] Objective To explore the different clinical effects of right internal jugular vein catheterization by medium pathway of triangle in sternocleidomastoid and anterior side of carotid artery under general anesthesia. Methods From September 2004 to September 2014，100 patients accepted general anesthesia in our hospital were randomly selected.They were provided with right internal jugular vein catheterization，and evenly divided into anterior side of carotid artery catheterization group（n=50） and medium pathway catheterization of triangle in sternocleidomastoid group（n=50）.The success rate and incidence of adverse reaction between two groups were comparatively analyzed. Results There were 48 cases in success anterior side of carotid artery catheterization group， accounting for 96%.Only 2 cases were in failure.In the medium pathway catheterization of triangle in sternocleidomastoid group，40 cases were successful，accounting for 80%，10 cases were failure，accounting for 20% with statistical difference（P<0.05）.There were two cases puncturing into artery mistakenly in 4%，greatly lower than that in the medium pathway catheterization of triangle in sternocleidomastoid group，accounting for 24%（n=12），with statistical difference （P<0.05）. Conclusion Right internal jugular vein catheterization under general anesthesia can obtain a more remarkable effect and higher safety by anterior side of carotid artery catheterization，which is worthy of application and expansion in clinical.

[Key words] General anesthesia；Right internal jugular vein catheterization；Clinical effect；Carotid artery；Triangle of sternocleidomastoid

中心静脉压监测、危重患者抢救用药通道及全胃肠道外营养支持等均需颈内静脉穿刺置管，由于手术操作的危险性较大，可能引发纵隔血肿、感染、神经损伤及心律失常等并发症，所以需要合理选择穿刺路径[1]。实践证明，按右颈内静脉与周围组织关系，分为前、中与后路3种路径。本研究纳入本院近10年来收治的全身麻醉患者100例，对比分析经胸锁乳突肌三角中路穿刺置管与经颈动脉旁前路置管的临床效果。

1 资料与方法

1.1 一般资料

随机选取2004年9月～2014年9月本院收治的全身麻醉患者100例，根据全身麻醉分级，分为Ⅰ～Ⅱ级，男性64例，女性36例，年龄19～79岁，平均（42.4±4.7）岁，患者体重48～80 kg，平均（67.4±3.4） kg，胸外科手术患者20例、普外科手术患者40例、妇科手术患者20例及骨科手术患者20例。将研究纳入的100例患者随机分成两组，即经颈动脉旁前路穿刺置管组50例、经胸锁乳突肌三角中路穿刺置管组50例。……