生理盐水快速灌注超声显像技术在中心静脉导管尖端位置评估中的应用  

Application value of ultrasound imaging by rapid saline infusion in the confirmation of the central venous catheter placement

作　　者：沈鹏[1] 赵连泽 赵慧颖[1] 吕杰[1] 安友仲[1] Shen Peng;Zhao Lian-Ze;Zhao Hui-Ying;Lv Jie;An You-Zhong(Department of Critical Care Medicine,Peking University People′s Hospital,Beijing 100044,China;Department of Emergency Surgery,Shuguang Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]北京大学人民医院重症医学科,北京100044 [2]上海中医药大学附属曙光医院创伤急救科,上海201203

出　　处：《解放军医学杂志》2022年第9期922-925,共4页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨采用生理盐水快速灌注超声显像技术迅速评估中心静脉导管尖端位置的可行性。方法纳入2020年7月-2021年7月北京大学人民医院收治的具有中心静脉置管指征的急危重症成人患者83例,通过超声检查观察中心静脉导管内快速推注生理盐水后形成的湍流显像以迅速判断导管尖端的确切位置,并与床旁胸部X线检查结果进行对比,评估生理盐水快速灌注超声显像检查方法的有效性。结果生理盐水快速灌注超声显像与床旁胸部X线检查判断中心静脉导管尖端位置的结果基本一致(Kappa=0.917,P<0.05)。应用生理盐水灌注超声显像判断导管尖端位置的敏感度为100.0%(95%CI 94.0%~100.0%),特异度为85.7%(95%CI 42.0%~99.2%)。采用胸部X线检查判断导管尖端位置耗时77.5(69.5,85.5)min,明显长于生理盐水灌注超声显像的耗时[6.4(5.8,6.9)min],差异有统计学意义(P<0.05)。结论应用生理盐水快速灌注超声显像技术可有效判断中心静脉导管尖端的位置,且耗时较床旁胸部X线检查短。Objective To explore the feasibility of rapid saline infusion ultrasound imaging for the assessment of the central venous catheter tip location.Methods A total of 83 critically ill adult patients with indications for central venous catheterization who were admitted to Peking University People's Hospital from July 2020 to July 2021 were selected.Cardiac ultrasonography was used to observe the turbulent flow imaging formed after rapid injection of normal saline into the central venous catheter to quickly determine the exact position of the catheter tip,and compared with the results of bedside chest X-ray to evaluate the method of rapid injection of normal saline effectiveness.Results The results of judging the position of the tip of the central venous catheter by the rapid perfusion ultrasound imaging of normal saline and bedside chest X-ray were basically consistent(Kappa=0.917,P<0.05).The rapid saline infusion ultrasound imaging had a sensitivity of 100.0%(95%CI 94.0%-100%)and specificity of 85.7%(95%CI 42.0%-99.2%).It took 77.5(69.5,85.5)minutes to determine the catheter position by chest X-ray,which was significantly longer than that of normal saline perfusion ultrasound imaging[6.4(5.8,6.9)minutes],and the difference was statistically significant(P<0.05).Conclusion The rapid saline infusion ultrasound imaging can effectively determine the tip position of the central venous catheter and the diagnosis time is shorter than that of the bedside chest X-ray examination.

关 键 词：危重症 超声检查 中心静脉置管 

分 类 号：R459.7[医药卫生—急诊医学]