床边实时超声在危重症新生儿脐静脉置管中的应用  

Application of bedside real-time ultrasound in umbilical vein catheterization of critically ill neonates

作　　者：谢浩强 廖金凤 杜邦 钟柏茂 XIE Haoqiang;LIAO Jinfeng;DU Bang;ZHONG Baimao(Department of Neonatology,Dongguan Children′s Hospital Affiliated to Guangdong Medical University,Dongguan,Guangdong,523325)

机构地区：[1]广东医科大学附属东莞儿童医院新生儿科,广东东莞523325

出　　处：《实用临床医药杂志》2023年第11期89-93,共5页Journal of Clinical Medicine in Practice

基　　金：2022年度广东省卫生健康适宜技术推广项目(202206251927304839)。

摘　　要：目的探讨床边实时超声在危重症新生儿脐静脉置管中的应用价值。方法纳入行脐静脉置管的新生儿126例,其中2019年4—12月的75例新生儿作为对照组,2020年1月—2021年1月的51例新生儿作为研究组。对照组采用盲插法置管,并行标准胸腹X线定位;研究组行床边超声引导下脐静脉置管,并以导管末端位于下腔静脉-右心房交汇处为标准进行定位。比较2组一次性置管成功率、脐静脉导管平均使用时间、脐静脉置管失败原因及并发症发生率。结果研究组一次性置管成功率为82.35%,导管中位使用时间为5 d,均高于对照组的65.33%、4 d,差异有统计学意义(P<0.05)。研究组置管失败拔管率为17.65%,低于对照组的34.67%,差异有统计学意义(P<0.05)。研究组计划中拔管率为72.55%,与对照组56.00%比较,差异无统计学意义(P>0.05)。置管失败拔管主要以进入脐静脉置管解剖路径外的门脉分支为主,其中对照组20例(26.67%),研究组6例(11.76%),差异有统计学意义(P<0.05)。对照组发生不良并发症7例(9.33%),研究组4例(7.84%),差异无统计学意义(P>0.05)。2组成功置管导管尖端主要位于膈上0-1 cm;对照组有7例(9.33%)导管尖端位于膈下,1例(1.33%)导管尖端位于膈上>1 cm。2组成功置管导管尖端主要对应T_(7)-T_(9)椎体,差异无统计学意义(P>0.05)。结论床旁实时超声引导脐静脉置管较传统盲插法置管的一次性置管成功率高,平均使用时间较长,置管失败拔管率低,且具备无创和无辐射等特点。脐静脉置管术后48 h容易发生移位;当导管末端发生移位时,超声定位较标准X线定位准确。Objective To explore the application value of bedside real-time ultrasound in umbilical vein catheterization of critically ill neonates.Methods A total of 126 neonates with umbilical vein catheterization were enrolled,and 75 neonates from April to December 2019 were designed as control group,the other 51 neonates from January 2020 to January 2021 were designed as study group.Blind insertion method for catheterization and the standard chest abdominal X-ray localization were performed in the control group;the bedside ultrasound guided umbilical vein catheterization was performed in the study group,and localization based on catheter end at the intersection of the inferior vena cava and right atrium was performed.The success rate of catheterization by one time,the average use time of umbilical vein catheter,the causes of failure in umbilical vein catheterization and the incidence of complications were compared between the two groups.Results The success rate of catheterization by one time and the median use time of catheter were 82.35% and 5 days in the study group,which were significantly higher than 65.33%and 4 days in the control group(P<0.05).The extubation rate due to failure in catheterization was 17.65%in the study group,which was significantly lower than 34.67%in the control group(P<0.05).The planned extubation rate was 72.55%in the study group and 56.00%in the control group,and there was no significant difference between two groups(P>0.05).The extubation caused by failure in catheterization was mainly due to the umbilical vein catheterization entering the branch of the portal vein outside the anatomical pathway,and there were 20 cases(26.67%)in the control group and 6 cases(11.76%)in the study group,which showed a significant between-group difference(P<0.05).There were 7 cases(9.33%)with adverse complications in the control group and 4 cases(7.84%)in the study group,but no significant between-group difference was observed(P>0.05).In the cases with successful catheterization in both groups,the tip of the cathe

关 键 词：床边超声 脐静脉置管 危重症新生儿 传统盲插法 拔管率 

分 类 号：R472[医药卫生—护理学] R445.1[医药卫生—临床医学]