不同体质量新生儿PICC导管末端位置对继发性乳糜胸的影响  

Effect of terminal position of PICC catheter on secondary chylothorax in neonates of different body weight

作　　者：陈小玲[1] 陈倪[1] 谢伟纯 Chen Xiaoling;Chen Ni;Xie Weichun(Department of Neonatology,Shantou Central Hospital,Affiliated Shantou Hospital of Sun Yat-Sen University,Shantou 515031,China)

机构地区：[1]汕头市中心医院新生儿科,汕头515031

出　　处：《国际医药卫生导报》2022年第24期3535-3538,共4页International Medicine and Health Guidance News

摘　　要：目的探讨不同体质量新生儿留置经外周静脉穿刺置入中心静脉导管(PICC)后导管末端位置与继发性乳糜胸的相关性。方法回顾分析汕头市中心医院新生儿科从2013年11月至2020年12月PICC新生儿689例,置管后发生乳糜胸的新生儿共6例,通过与PICC导管末端位置、体质量因素行相关性分析。采用Fisher确切概率法。结果6例继发性乳糜胸新生儿(其中男5例,女1例,5例体质量在1.0~1.5 kg之间,1例为1.9 kg)均经右贵要静脉行PICC置管,行胸片检查,其中5例导管末端位于T2右侧,1例位于T1位置,6例新生儿经胸穿抽液、禁食、补液及呼吸支持等对症处理后均痊愈出院,结果显示导管末端位于T2与非T2(在1.0~1.5 kg、1.5~2.0 kg以及整体中比对)乳糜胸发生率的差异均有统计学意义(均P<0.05);各体质量组之间乳糜胸发生率比较,差异无统计学意义(P>0.05)。结论PICC导管末端位于T2位置为新生儿继发性乳糜胸的危险因素,应尽量避免留置于T2位置。对PICC导管末端位置处于T2等远离中心位置的新生儿应定期行X线检查定位导管末端位置,以减少新生儿继发性乳糜胸等并发症。Objective To explore the risk of secondary chylothorax associated with catheter tip position after peripherally inserted central catheter(PICC)in neonates of different body weight.Methods A total of 687 neonates with PICC were collected from Department of Neonatology,Shantou Central Hospital from November 2013 to December 2020.Among them,6 neonates developed chylothorax after catheterization.Related risks were analyzed through PICC catheter tip position and body weight factor.Fisher exact probability method was used.Results Six neonates with secondary chylothorax(including 5 males and 1 female,5 neonates with body weight of 1.0-1.5 kg and 1 neonate with body weight of 1.9 kg)underwent PICC catheterization via the right basilic vein,and chest radiography indicated that the catheter tip was located on the right side of T2 in 5 cases and T1 in 1 case.All the 6 neonates were cured and discharged from the hospital after symptomatic treatment including thoracentesis,fasting,fluid replacement,and respiratory support.There were statistically significant differences in the incidence of chylothorax between the catheter tip at T2 and non-T2 groups(1.0-1.5 kg,1.5-2.0 kg,and overall)(all P<0.05).There was no statistically significant difference in the incidence of chylothorax among all the body weight groups(P>0.05).Conclusions PICC catheter tip at T2 position may be a high-risk factor for neonatal secondary chylothorax,which should be avoided as far as possible.X-ray should be performed regularly to locate terminal position of the catheter in neonates with catheter tip at T2 position away from the center to reduce the influence of secondary chylothorax and other complications.

关 键 词：新生儿 PICC 导管末端 乳糜胸 

分 类 号：R722.1[医药卫生—儿科]