低出生体质量儿外周置入中心静脉导管尖端位置与体质量及摄片体位的相关性分析  

Correlation analysis of peripherally inserted central catheter tip position with body weight and body position in low birth weight infants

作　　者：郑蒙 付佳 任洪伟 刘慧娟 高彦彦 蔡剑鸣 ZHENG Meng;FU Jia;REN Hongwei;LIU Huijuan;GAO Yanyan;CAI Jianming(Department of Diagnostic Radiology,the Fifth Medical Center of PLA General Hospital,Beijing 100039,China;Department of Neonatology,the Fifth Medical Center of PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第五医学中心放射诊断科,北京100039 [2]解放军总医院第五医学中心新生儿疾病诊疗科,北京100039

出　　处：《实用放射学杂志》2022年第6期976-979,共4页Journal of Practical Radiology

摘　　要：目的探讨经外周置入中心静脉导管(PICC)的尖端位置与低出生体质量儿的体质量及体位变化的相关性.方法回顾性分析低出生体质量儿留置PICC期间床旁胸片,记录胸片上的PICC尖端位置、新生儿置管侧上肢与身体长轴夹角、新生儿出生体质量及摄片日体质量.计算摄片当日和上次相比的PICC尖端位置改变及体质量变化率,采用Spearman's等级相关法分析胸片上PICC尖端移位和不同置管静脉、体质量变化率及置管侧上肢与身体长轴夹角之间的关系.结果共40例留置PICC的低出生体质量儿所摄131张床旁胸片纳入研究.出生体质量为940.00~1980.00 g,平均(1376.12±21.32)g;日龄为1~86 d,平均(17.29±15.08)d;体质量变化率为-7.38%~52.11%,中位数和四分位间距为8.59%(2.29%,16.40%);置管侧上肢与身体长轴夹角变化0~146°,平均(9.89±50.39)°;84.6%的患儿PICC尖端位置出现改变,中位数和四分位间距为-5(-2,1)个肋间隙,其中75%出现1个肋间隙以上的移位,50%向头侧移位5个肋间隙.PICC尖端位置改变和置管侧上肢与身体长轴夹角变化显著相关(r_(s)=-0.455,P<0.01),但体表穿刺部位不同时二者的相关性有差异.PICC尖端移位的幅度和体质量变化率无显著相关性(r_(s)=-0.143,P=0.177).结论低出生体质量儿的PICC尖端位置受摄片时患儿置管侧上肢与身体长轴夹角影响,建议拍摄床旁胸片时将患儿双上肢外展90°并固定.Objective To investigate the correlation between the tip position of peripherally inserted central catheter(PICC)and the changes of body weight and posture in low birth weight infants.Methods The bedside chest films of low birth weight infants during PICC indwelling were analyzed retrospectively.The tip position of PICC on chest films,the angle between the upper limb on the side of catheterization and the long axis of the body,the birth weight of newborns and the weight on the day of photography were recorded.The change of PICC tip position and body weight change rate was calculated on the same day and last time.Spearman's rank correlation method was used to analyze the relationship between PICC tip shift and different catheterization vein,body weight change rate and the angle between the upper limb on the side of catheterization and the long axis of the body.Results A total of 131 bedside chest films taken from 40 low birth weight infants with PICC were included in the study.The birth weight was 940.00-1980.00 g,mean(1376.12±21.32)g,the age was 1-86 d,mean(17.29±15.08)d,the change rate of body weight was -7.38%-52.11%,the median and quartile spacing was 8.59%(2.29%,16.40%).The angle between the upper limb on the side of catheterization and the long axis of the body changed by 0-146°,mean(9.89±50.39)°.The tip position of PICC changed in 84.6% of the children,with a median and quartile spacing of-5(-2,1)intercostal spaces,of which 75% had more than 1 intercostal gap displacement,and 50% shifted 5 intercostal spaces to the head side.There was a significant correlation between the change of the tip position of PICC and the change of the angle between the upper limb on the side of catheterization and the long axis of the body(r_(s)=-0.455,P<0.01),the correlation was different between different puncture sites on the body surface.There was no significant correlation between the amplitude of PICC tip shift and the change rate of body weight(r_(s)=-0.143,P=0.177).Conclusion The PICC tip position of low birth weight

关 键 词：低出生体质量儿 外周置入中心静脉导管尖端位置 体质量变化率 体位变化 

分 类 号：R722.1[医药卫生—儿科] R816.92[医药卫生—临床医学]