早产儿脐动脉置管的临床应用及并发症分析  

Clinical application and complication analysis of umbilical arterial catheterization in premature infants

作　　者：茹喜芳[1] 冯琪[1] 王颖[1] 岳慧轩 桑田[1] 黄晓芳[1] 李珊[1] 杜雪燕 Ru Xifang;Feng Qi;Wang Ying;Yue Huixuan;Sang Tian;Huang Xiaofang;Li Shan;Du Xueyan(Department of Pediatrics,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院儿科,北京100034

出　　处：《中华新生儿科杂志（中英文）》2024年第2期84-89,共6页Chinese Journal of Neonatology

摘　　要：目的分析早产儿脐动脉置管的临床应用和并发症情况。方法选择2021年1月至2022年12月北京大学第一医院新生儿重症监护病房成功留置脐动脉导管(umbilical arterial catheter,UAC)的早产儿为研究对象,按照出生体重分为<1000 g组、1000~1499 g组和≥1500 g组,对其围生期资料、UAC留置及使用情况、UAC相关并发症情况、UAC相关并发症的危险因素等进行回顾性分析。结果研究期间共有39例早产儿留置UAC,胎龄29.3(27.3,30.4)周,出生体重1100(900,1310)g。"高位"置管采用置管长度(cm)=4×体重(kg)+7和置管长度(cm)=3×体重(kg)+9两种公式计算后的平均值确定置管长度。置管后胸腹X线片显示,30例(76.9%)管端位置恰当,6例(15.4%)管端位置高,3例(7.7%)管端位置低(均为T10,1例调整为"低位"置管使用)。<1000 g组、1000~1499 g组和≥1500 g组管端位置恰当的比例分别为80.0%、76.5%和71.4%,差异无统计学意义(P>0.05);3组UAC留置时长和UAC常规拔除比例比较,差异亦无统计学意义(P>0.05)。非常规拔除UAC共9例(23.1%),包括动脉痉挛4例,家长放弃治疗2例,导管尖端移位、腹胀、死亡各1例。21例以0.9%的氯化钠配置1 U/ml肝素0.5~1 ml/h持续动脉输注,5例发生高钠血症,降低氯化钠浓度后血钠正常。4例UAC置管后出现动脉痉挛的患儿表现为一侧下肢皮肤颜色改变,拔除UAC后下肢皮肤颜色恢复正常。结论UAC对于早产儿的救治是重要且安全的,但临床应用中仍需警惕其相关并发症的发生。Objective To study the clinical application and complications of umbilical arterial catheterization(UAC)in premature infants.Methods From January 2021 to December 2022,premature infants with UAC successfully inserted in NICU of our hospital were enrolled.According to birth weight(BW),the infants were assigned into three groups:<1000 g,1000~1499 g and≥1500 g.The perinatal data,UAC usage,UAC-related complications and risk factors of UAC-related complications were retrospectively analyzed.Results A total of 39 premature infants received UAC,with gestational age 29.3(27.3,30.4)weeks and BW 1100(900,1310)g.The insertion length(IL)of UAC was calculated using the average value of two formulas:a,IL(cm)=4×BW(kg)+7;and b,IL(cm)=3×BW(kg)+9.The accuracy of tube end position was determined using chest/abdomen radiography.30(76.9%)cases had accurate position,6(15.4%)had higher position and 3(7.7%)had lower position.The proportion of appropriately positioned tube end in<1000 g,1000~1499 g and≥1500 g groups were 80.0%,76.5%and 71.4%,respectively,without statistically significant differences(P>0.05).No significant differences existed among the three groups in UAC duration and UAC routinely removal rate(P>0.05).9 cases(23.1%)of UAC were removed for specific reasons,including 4 cases of arterial spasm,2 cases of withdrawal of treatment,1 case of tube end displacement,1 case of abdominal distension and 1 case of death.21 cases received 1 U/ml heparin(0.9%NaCl solution)0.5~1 ml/h arterial infusion.23.8%(5/21)had hypernatremia and the level of sodium became normal after reducing the concentration of NaCl solution.Arterial vasospasm occurred in 4 patients with skin color changes of one side of the lower extremities.After UAC removal,the skin color returned to normal.Conclusions UAC is helpful and safe for preterm infants,however,its complications should be alerted to.

关 键 词：脐动脉导管 导管留置 并发症 早产儿 

分 类 号：R722.6[医药卫生—儿科]