成人PICC导管末端定位的影像学探讨  

The study of localizing adult PICC catheter tip by plain-film

作　　者：尤佳[1] 徐凯[1] 李伟栋[1] 李菁菁[1] 朱明芝[2] 马红[1] 荣玉涛[1] 

机构地区：[1]徐州医学院附属医院影像科,江苏徐州221002 [2]徐州医学院附属医院甲乳外科,江苏徐州221002

出　　处：《实用放射学杂志》2015年第2期204-207,233,共5页Journal of Practical Radiology

基　　金：徐州医学院课题（2012KJ25）;国家自然科学基金（21305120）;江苏省高校自然科学研究面上项目（13KJB150036）.

摘　　要：目的：探讨成人上腔静脉的 X线解剖学标志及其在经外周静脉置入中心静脉导管（PICC）末端定位中的应用价值。方法回顾性分析219例PICC置管患者的胸片,其中57例患者1周内行胸部CT检查,测量并记录气管隆突至心影右上缘或心房腔静脉连接处（CAJ）、右支气管角以及PICC导管末端的垂直距离,将所得数据进行统计分析。57例患者胸片和 CT中所测的数据分为胸片组和CT组并对2组进行统计分析。结果胸片组患者的气管隆突至CAJ、右支气管角和PICC导管末端的距离和CT组的差异均无统计学意义（P值均〉0.05）,胸片组的以上3组测量值和 CT组存在正相关关系（r=0.744,0.332,0.778,P 值均〈0.05）。胸片组判断PICC导管末端位置情况与CT组判断的差异无统计学意义（P值〉0.05）,2组的吻合系数k=0.542,吻合度有统计学意义（P值〈0.05）。219例患者胸片中气管隆突至心影右上缘的平均垂直距离为（3.21±0.84）cm；气管隆突至右支气管角的平均垂直距离为（1.38±0.28）cm,以上测量值男性均高于女性（P 值〈0.05）。结论采用气管隆突、右支气管角及心影右上缘作为成人上腔静脉和PICC导管末端 X线定位的影像学标志科学且准确。气管隆突至右支气管角、心影右上缘的平均距离可作为临床判断PICC导管末端位置的参考依据。Objective To explore X-ray anatomical landmarks of adult superior vena cava and their applications for localizing cath-eter tip of PICC placement.Methods The authors retrospectively reviewed chest radiographs of 2 1 9 PICC insertions,and 5 7 of them were carried out with chest CT scan in a week.For each patient,the vertical distances from the carina to the right superior heart bor-der or the cavoatrial j unction（CAJ）,the right tracheobronchial angle and PICC tip position were measured,recorded,and analyzed, respectively.The obtained data from 5 7 patients were divided into chest X-ray group and CT group,which were then statistically an-alyzed accordingly.Results Between chest X-ray group and CT group,the vertical distances from the carina to CAJ,the right tra-cheobronchial angle and PICC tip position had no significant difference （each P〉0.05）and showed positive correlation（r=0.744, 0.332,0.778,each P〈0.05）.No significant difference existed in PICC catheter tip locations estimated by chest X-ray group and by CT group （P〉0.05）.The matching coefficient was k=0.542 and was statistical difference （P〈0.05）.The mean vertical distance from the carina to the right superior heart border was （3.21±0.84）cm and from the carina to the right tracheobronchial angle was （1.38±0.28）cm.The above measured values in males were higher than in females（P〈0.05）.Conclusion It is applicable and ac-curate that using the carina,right tracheobronchial angle and right superior heart border as the radiographic landmarks for adult supe-rior vena cava and catheter tip positioning of PICC placement.The average vertical distances from the carina to the right tracheo-bronchial angle,and to the right superior heart border in the chest X-rays can provide reference basis for j udging PICC catheter end position in clinical.

关 键 词：经外周静脉置入中心静脉导管 放射摄影术 计算机体层成像 导管末端位置 

分 类 号：R814.49[医药卫生—影像医学与核医学] R814.41[医药卫生—放射医学]