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 cm H2O)、B组(PEEP=5cm H2O)、C组(PEEP=10 cm H2O)、D组(PEEP=15 cm H2O)。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.
出处
《中国临床解剖学杂志》
CSCD
北大核心
2015年第5期601-603,607,共4页
Chinese Journal of Clinical Anatomy
基金
国家科技支撑计划(2011BAI11B22)
关键词
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
