超声引导下婴幼儿心脏手术颈内静脉置管深度的测量定位研究  

Measurement and localiztion of the depth of internal jugular vein catheterization under the guidance of ultrasound for pediatric patients in heart surgery

作　　者：梁冰 徐辉[2] LIANG Bing;XU Hui(Department of Anesthesiology,Pediatric Hospital of Fudan University,Shanghai 200000,China;Department of Anesthesiology,the Ninth People′s Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200000,China)

机构地区：[1]复旦大学附属儿科医院麻醉科,上海200000 [2]上海交通大学附属第九人民医院麻醉科,上海200000

出　　处：《河北医科大学学报》2023年第3期342-346,共5页Journal of Hebei Medical University

基　　金：上海市卫生局重点资助项目(20204027)。

摘　　要：目的 探讨在超声引导下测量定位颈内静脉导管放置深度的准确率。方法 选择全身麻醉下行先天性心脏病矫治手术的患儿96例。按随机数字表法将其分为研究组与对照组,每组48例。研究组患儿采用超声引导定位颈内静脉导管尖端放置位置并测量导管放置深度。对照组患儿采用体表标志定位法测量颈内静脉导管放置深度。比较两组颈内静脉导管放置深度,术后所有患儿采用胸部X光用于确定超声定位的导管尖端是否在T4段内。采用Bland-Altman法分析两种方法与术后胸片定位法的一致性。结果 两组患儿均成功放置导管,无并发症。研究组测量的放置导管深度与对照组测量放置深度相比更浅[(6.17±0.90) cm vs.(6.59±0.94) cm,P<0.05]。且对照组在正确检测深静脉导管尖端位置与胸部X线片的符合率为81.25%,研究组为97.91%,两种方法比较差异有统计学意义(P<0.05)。Bland-Altman一致性分析显示研究组定位颈内静脉导管置入深度与穿刺点到气管隆突的距离一致性较高。结论 超声指导婴幼儿颈内静脉置管深度定位可动态、直接地引导和定位穿刺和放置位置,比体表标志定位法更直观、准确。Objective To investigate the accuracy of measurement and localization of the depth of internal jugular vein catheterization under the guidance of ultrasound.Methods A total of 96 patients who underwent surgery for congenital heart disease(CHD) under general anesthesia were selected.They were divided into a research group(n=48) and a control group(n=48) according to random number table method.The patients in the research group were guided by ultrasound to locate the placement of the tip of the internal jugular vein catheter and measure the placement depth of the catheter.In the control group,the body surface landmark positioning method was used to measure the placement depth of the internal jugular vein catheter,and the differences in the placement depth of the internal jugular vein catheter were compared between two groups.After surgery,chest X-ray was used to determine whether the catheter tip located by ultrasound was within the T4 segment.The Bland-Altman method was used to analyze the consistency between two methods and the postoperative chest X-ray localization method.Results The catheters were successfully placed in both groups without complications.The depth of catheter placement measured in the research group was smaller than that in the control group [(6.17±0.90) cm vs.(6.59±0.94) cm,P<0.05].The coincidence rate between the correct detection of the position of the deep venous catheter tip and the chest X-ray was 81.25% in the control group and 97.91% in the research group,and there was a statistical difference between two methods(P<0.05).Bland-Altman consistency analysis showed that the research group had a high consistency between the depth of positioning the internal jugular vein catheter and the distance from the puncture point to the tracheal carina.Conclusion Ultrasound-guided depth positioning of internal jugular vein catheterization in infants and young children can dynamically and directly guide and locate the puncture and placement position,which is more intuitive and accurate than body surfac

关 键 词：先天性心脏病 超声检查 婴幼儿 

分 类 号：R541[医药卫生—心血管疾病]