超声显像技术观察小儿颈内静脉与颈总动脉解剖关系的临床研究

黄应思; 刘洋; 徐海平; 杨利; 冯龙; 袁维秀

doi:10.3969/j.issn.2095-5227.2022.04.008

超声显像技术观察小儿颈内静脉与颈总动脉解剖关系的临床研究

Anatomic relationship between internal jugular vein and common carotid artery in children: An ultrasonographic study

摘要

摘要:
背景小儿头大、颈短、胸锁乳突肌显露不明显，传统盲穿法失败概率高，超声显像技术可无创显露目标血管图像，为小儿颈内静脉穿刺提供参考。
目的通过超声显像技术观察小儿右侧颈内静脉与颈总动脉不同平面的解剖结构关系。
方法 2020年4 - 7月选取广州市妇女儿童医疗中心及解放军总医院海南医院4个月~ 11岁择期手术的患儿125例，男患儿82例，女患儿43例。将患儿分为婴儿组、幼儿组、学龄前儿童组和学龄儿童组，扫描每组患儿右侧甲状软骨上缘水平(upper border of the thyroid cartilage，TC)、环状软骨水平(cricoid cartilage，CC)和第二气管环水平(second tracheal ring，ST) 3个横截面。分别测量不同年龄组患儿不同平面的颈内静脉与颈总动脉的横径、前后径、横截面积、两者的重叠率、颈内静脉与颈总动脉夹角，记录两者之间的相互关系及变异情况。
结果幼儿组、学龄前儿童组，重叠距离：第二气管环水平＞环状软骨水平＞甲状软骨上缘，两两比较差异均有统计学意义(P＜0.05)；重叠率：第二气管环水平＞环状软骨水平＞甲状软骨上缘水平，两两比较差异均有统计学意义(P＜0.05)；婴儿组、学龄儿童组，不同解剖平面重叠情况与颈内静脉变异情况比较，差异均无统计学意义(P＞0.05)；四组不同解剖平面颈内静脉与颈总动脉相互关系比较，差异均无统计学意义(P＞0.05)。
结论超声显像技术提示1 ~ 6岁儿童在甲状软骨上缘水平动静脉重叠率及重叠距离最低，可优先选择该处作为临床颈内静脉穿刺点。

Abstract:
Background Children have the characteristics of heavy head, short neck, and unobvious sternocleidomastoid muscles. Thus, internal jugular vein puncture using anatomical landmarks technique is difficult to perform and carries a high incidence of failure in pediatric population. Ultrasound imaging technology can reveal the target blood vessel image non-invasively, providing a reference for pediatric internal jugular vein puncture.
Objective To investigate the anatomical relationship between the right internal jugular vein (IJV) and the common carotid artery (CCA) at different levels using ultrasound.
Methods From April to July in 2020, a total of 125 children scheduled for surgery aged from 4 months to 11 years in Guangzhou Women and Children’s Medical Center and Hainan Hospital of Chinese PLA General Hospital, including 82 males and 43 females, were included and divided into infant group (GA), toddler group (GB), preschool group (GC) and school-age group (GD). The transverse diameter, anteroposterior diameter, cross-sectional area of the IJV and the CCA, as well as the overlap rate and the angle between the two of each patient were scanned and measured at the right upper border of the thyroid cartilage level (TC), cricoid cartilage level (CC) and second tracheal ring level (ST) to record the relationship and variation between IJV and CCA.
Results Both in the GB and GC groups, the overlap distance and the overlap rate were ST>CC>TC, and the pairwise comparisons were statistically significant (all P<0.05), while no statistical difference of the overlap and IJV variation was obtained in the GA and GD groups (P>0.05). No difference of the position relationship between IJV and CAA was seen at three anatomical levels in all four groups (P>0.05).
Conclusion Ultrasound imaging technology indicates that the overlap rate and overlap distance of arteries and veins at the TC are the lowest in children aged 1 to 6 years, and this place can be the first choice in clinical practice as the IJV puncture point.

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