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題 名 | Sternocleoidomastoid Muscle Length Predicts Depth of Central Venous Catheter Insertion=胸鎖乳突肌長度預測中央靜脈導管深度 |
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作 者 | 陳昶馗; 譚培炯; 李泓振; | 書刊名 | 麻醉學雜誌 |
卷 期 | 45:4 2007.12[民96.12] |
頁 次 | 頁211-215 |
分類號 | 416.5 |
關鍵詞 | 心電圖; 中央靜脈導管置放術:深度; 頸部肌肉:胸鎖乳突肌; Electrocardiography; Catheterization, central venous: depth; Neck muscles: sternocleidomastoid muscle; |
語 文 | 英文(English) |
中文摘要 | 背景:正確地並且避免心臟內的置放中央靜脈導管是相當重要的。在此之前只有少數的方法討論到中央靜脈導管深度的問題。利用體表解剖標記方式預測中央靜脈導管深度是最容易快速的方法並且是最被廣泛使用。胸部X光被認為是檢查中央靜脈導管深度的標準程序。但是,胸部X光無法常規性地執行,特別是在緊急的情況。在近幾年的文獻報告中認為經由心電圖導引置放中央靜脈導管的準確性可以取代胸部X光。因此,我們希望藉由心電圖為導引找出體表解剖標記和中央靜脈導管深度相關性,並且快速和容易使用的方法去預測中央靜脈導管的深度。方法:三十位接受全身麻醉骨科、神經和腸胃外科手術的病人選擇為右邊頸部中央靜脈導管的置放。下針點高度是固定在胸鎖乳突肌的中點、與表皮夾角30-45度、向著乳頭的方向。我們利用心電圖為導引找出中央靜脈導管的深度。測量的解剖參數包括身高、坐高、胸骨和胸鎖乳突肌的長度。結果:胸鎖乳突肌的長度和身高對預測中央靜脈導管皆有統計上的意義。另外來說,因為胸鎖乳突肌的長度有較低的P值,可能再此扮演更明顯的角色。而且大約等於胸鎖乳突肌長度的一半加上6.5公分(年齡18 至78歲)。結論:我們相信我們找到一個簡單、準確、可以快速利用的方法經由體表解剖位置預測中央靜脈導管深度。 |
英文摘要 | Background: Correct central venous catheter (CVC) insertion avoids serious complications, especially fatal intracardiac impalement. There are only fewmethods which discussed thedepth ofCVC insertion previously. Predicting the depth of CVC by body surface landmark is an easy and quick way,which is appliedmost wildly. Chest X-ray is a standard procedure to examine the depth of CVC. However, chest X-ray is not routinely availale, especially in emergency situations. Recent publications demonstrated that the determination of accurate placement by chest X-ray can be substituted byECG guidance. We would like to find the correlation between surface anatomic landmarks and the depth of CVC insertion, and a method that could be applied easily and quickly to predict the depth of CVC insertion through ECG guidance. Methods: Thirty patients receiving orthopedic, neurologic and gastrointestinal operations under general anesthesia were chosen for the study of CVC insertion via the right internal jugular vein puncture. The puncture site is at the mid-point of sternocleidomastoid (SCM) muscle, and direction of puncture is 30-45°, pointing to nipple. ECG guidance is applied for the depth of CVC measurement. Body height, sitting height, length of sternum and SCMmuscle were measured for reference. Results: Both the length of SCM muscle and body height have statistically meaning for predicting the depth of CVC insertion (P<0.001 vs. P=0.012). In point of accuracy, SCMmuscle length might be more significant in view of yielding a smaller P-value. And, the depth of CVC is equal to half of the length of SCMmuscle plus 6.5 cm in adults aged 18 to 78 yrs. |
本系統中英文摘要資訊取自各篇刊載內容。