体位改变对完全植入式静脉输液港导管头端位置影响  

The effect of body posture change on the catheter tip position of totally implantable venous access port

作　　者：咸玉涛 杨正强[1] 夏金国[1] 王磊[1] 施海彬[1] 

机构地区：[1]南京医科大学第一附属医院介入放射科,210029

出　　处：《介入放射学杂志》2018年第1期20-23,共4页Journal of Interventional Radiology

摘　　要：目的探讨患者体位改变对完全植入式静脉输液港(TIVAP)导管头端位置的影响。方法超声导引下床边穿刺颈内静脉或锁骨下静脉植入TIVAP。术后摄立位和卧位X线胸片确认导管头端位置,分别测量X线胸片上第一胸椎上缘至导管头端距离。通过两者长度测量差异和固定体表标志判断导管头端位置移动。结果 86例恶性肿瘤患者成功植入TIVAP。有71例体位由立位改变为卧位时TIVAP导管头端向足侧移位,平均移位(12.29±7.48)mm;13例向头侧移位,平均移位(5.00±3.79)mm;2例无变化。TIVAP导管头端位置在立位改变为卧位时有向足侧移位倾向,平均移位(-9.32±9.36)mm,差异有显著统计学意义(P<0.0001);性别、年龄、身高、体重、体质指数与导管头端位置变化程度间差异均无统计学意义(P>0.05)。结论 TIVAP植入后导管头端位置会随患者体位变化发生改变,由立位变为卧位时导管头端易向心房内移动。Objective To discuss the effect of body posture change on the catheter tip position of totally implantable venous access port （TIVAP）. Methods Under ultrasound guidance, implantation of TIVAP was carried out through bedside puncturing of internal jugular vein or subclavian vein. After the implantation of TIVAP, X-ray chest films of both erect position and supine position were taken to check the catheter tip position. The distance from the upper edge of the first thoracic vertebra to the catheter tip was separately measured on the erect position and supine position chest films. The shift of the catheter tip position was judged by the difference in the distance measured on chest films as well as by the comparison with the bony anatomic marks. Results Successful implantation of T1VAP was accomplished in 86 patients. When the patients changed from erect position to supine position, the catheter tip of TIVAP moved caudally in 71 patients, with the mean displace distance being （12.29_＋7.48） ram; the catheter tip of TIVAP moved eephalad in 31 patients, with the mean displace distance being （5.00_＋3.79） ram; and the catheter tip of TIVAP remained in the same position in 2 patients. When the patients changed from erect position to supine position, the catheter tip of T[VAP had a tendency to move toward the fo^t side, the ~ve^age displace distance was （-9.32＋9.36） mm, the difference in catheter tip location between two photographic positions was statistically significant （P〈0.000 1 ）. No statistically significant correlation existed between the changes of catheter tip position and the sex, age, height, weight as well as body mass index （P〉0.05）. Conclusion After the implantation of TIVAP, the position of catheter tip will change with patient＇s body posture. When patient＇s posture changes from erect position to supine position the tip of the catheter tends to shift towards the atrium. （J Intervent Radiol, 2018, 27： 20-23）

关 键 词：完全植入式静脉输液港 导管 位置变化 立位 卧位 

分 类 号：R284[医药卫生—中药学]