床旁超声诊断中心静脉导管置入术中导丝尖端异位的准确性  

Accuracy of point-of-care ultrasound in diagnosis of guidewire tip misplacement during central venous catheterization

作　　者：于晖[1] 张莹[1] 李俊峰 时迎斌[1] 李海[1] 赵楠楠[1] 王向阳[2] 刘聚源[3] 左明章[1] Yu Hui;Zhang Ying;Li Junfeng;Shi Yingbin;Li Hai;Zhao Nannan;Wang Xiangyang;Liu Juyuan;Zuo Mingzhang(Department of Anesthesiology,Beijing Hospital National Center of Gerontology Institute of Geriatric Medicine Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Radiology,Beijing Hospital National Center of Gerontology Institute of Geriatric Medicine Chinese Academy of Medical Sciences,Beijing 100730,China;Infection Management Office,Beijing Hospital National Center of Gerontology Institute of Geriatric Medicine Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院手术麻醉科国家老年医学研究中心中国医学科学院老年医学研究院,100730 [2]北京医院手术放射科国家老年医学研究中心中国医学科学院老年医学研究院,100730 [3]北京医院感染管理处国家老年医学研究中心中国医学科学院老年医学研究院,100730

出　　处：《中华麻醉学杂志》2020年第5期614-617,共4页Chinese Journal of Anesthesiology

基　　金：北京医院临床研究121工程资助项目(BJ-2018-205);北京市东城区优秀人才培养资助(BJ-2019-012)。

摘　　要：目的评价床旁超声诊断中心静脉导管(CVC)置入术中导丝尖端异位的准确性。方法择期全麻手术需通过双侧颈内静脉或锁骨下静脉放置CVC的患者90例,性别不限,年龄18~90岁,BMI 15.5~44.8 kg/m2,ASA分级Ⅰ~Ⅳ级。使用超声探查并选定目标血管。静脉注射异丙酚、舒芬太尼和顺式阿曲库铵麻醉诱导,气管插管术后行正压通气。超声引导下中心静脉穿刺成功后置入导丝至预定长度,行床旁X线和床旁超声检查,确定导丝尖端位置,并进行记录。确定导丝尖端位置正常后置入CVC。使用Kappa一致性检验分析床旁超声和床旁X线诊断CVC置入术中导丝尖端异位的一致性;计算床旁超声诊断CVC置入术中导丝尖端异位的灵敏度、特异度、总符合率、误诊率、漏诊率、Youden指数、比数积、阳性预测值和阴性预测值。结果90例患者中17例发生了导丝尖端异位,导丝尖端异位发生率为19%。床旁超声与床旁X线诊断CVC置入术中导丝尖端异位具有一致性(Kappa值0.945,P<0.05)。床旁超声诊断CVC置入术中导丝尖端异位的灵敏度为97.44%,特异度为97.78%,总符合率为97.67%,误诊率为2.22%,漏诊率为2.56%,Youden指数为95.22%,比数积为1672,阳性预测值为95.00%,阴性预测值为98.88%。结论床旁超声可用于CVC置入术中导丝尖端异位的诊断。Objective To evaluate the accuracy of point-of-care ultrasound in diagnosis of guidewire tip misplacement during central venous catheterization.Methods Ninety patients of both sexes,aged 18-90 yr,with body mass index of 15.5-44.8 kg/m2,of American Society of Anesthesiologists physical statusⅠ-Ⅳ,scheduled for elective surgery with general anesthesia requiring central venous catheter(CVC)insertion through bilateral internal jugular veins or subclavian veins,were enrolled.The ultrasound probe was used,and the target vessel was selected.Anesthesia was induced with propofol,sufentanil and cisatracurium,and positive pressure ventilation was applied after endotracheal intubation.After central venous puncture was successfully performed under ultrasound guidance,the guidewire was inserted to a predetermined length,and the tips of the guidewire were confirmed with X-ray film and with point-of-care ultrasound including a phased array probe and linear array probe,and the results were recorded.The CVC was inserted after confirming the guidewire tip position.Agreement between the guidewire tip misplacement confirmed with point-of-care ultrasound and with bedside X-ray film was analyzed using Kappa statistics.The sensitivity,specificity,and total coincidence rate,rate of misdiagnosis,rate of missed diagnosis,Youden index,odds product,positive predictive value and negative predictive value of the guidewire tip misplacement were calculated during central venous catheterization confirmed using point-of-care ultrasound.Results Among the 90 patients,17 cases had guidewire tip misplacement,and the incidence of guidewire tip misplacement was 19%.Point-of-care ultrasound and bedside X-ray film were consistent in the diagnosis of guidewire tip misplacement during CVC insertion(Kappa value 0.945,P<0.05).The sensitivity of point-of-care ultrasound in diagnosing guidewire tip misplacement during CVC insertion was 97.44%,specificity 97.78%,total coincidence rate 97.67%,rate of misdiagnosis 2.22%,rate of missed diagnosis 2.56%,Youden ind

关 键 词：超声检查 导管插入术 中心静脉 导丝异位 

分 类 号：R472[医药卫生—护理学]