新生儿脐静脉置管/经外周中心静脉置管相关心包积液/胸腔积液10例临床分析  

Clinical analysis of pericardial effusion/pleural effusion associated with umbilical venous catheterization or peripherally inserted central catheterization in 10 neonates

作　　者：霍媛 陈冠初 李万怡 厚舒阳 高红霞[1] Huo Yuan;Chen Guanchu;Li Wanyi;Hou Shuyang;Gao Hongxia(Department of Neonatology,Gansu Province Maternity and Child Health Hospital,Gansu Provincial Central Hospital,Lanzhou 730050,China)

机构地区：[1]甘肃省妇幼保健院,甘肃省中心医院新生儿科,兰州730050

出　　处：《中华新生儿科杂志(中英文)》2025年第3期148-153,共6页Chinese Journal of Neonatology

基　　金：甘肃省自然科学基金(21JR11A168);兰州市科技计划项目(2023-ZD-12)。

摘　　要：目的分析新生儿脐静脉置管(umbilical venous catheterization, UVC)/经外周中心静脉置管(peripherally inserted central catheters, PICC)相关心包积液/胸腔积液的临床特征、超声表现及治疗。方法选择2022年1月至2024年8月甘肃省妇幼保健院新生儿重症监护病房收治的发生UVC/PICC相关心包积液/胸腔积液患儿的临床资料进行回顾性研究, 总结并分析患儿临床特征、超声表现、治疗及转归情况。结果研究期间共行深静脉置管528例, 其中PICC 218例(41.3%), UVC 310例(58.7%), 发生心包积液/胸腔积液10例(1.9%), UVC 7例, PICC 3例, 均由床旁超声检查发现。10例患儿中, 男4例, 女6例;9例早产儿, 7例出生体重<1 500 g。发生心包积液/胸腔积液时均有管端异位, 其中6例管端位于右心房, 1例位于卵圆孔附近, 2例位于T2椎体附近, 1例位于T9椎体水平;输注液体的渗透压为917.0(807.5, 1 011.3)mOsm, 中长链脂肪乳2.0(0.8, 3.0)g/(kg·d), 液量120(80, 140)ml/(kg·d), 输液速度为5.0(3.3, 5.8)ml/(kg·h)。7例发生心包积液, 1例为PICC, 6例为UVC, 平均发生于置管后2.7 d, 均表现为心率改变、呼吸困难, 均拔除静脉导管, 4例行心包穿刺治疗;3例发生胸腔积液, 其中1例为UVC, 2例为PICC, 平均发生于置管后9.0 d, 均表现为突然出现呼吸困难, 确诊后拔除静脉导管、胸腔穿刺后好转。10例均治愈, 其中8例正常出院, 2例超早产儿后期因心力衰竭/呼吸衰竭死亡。结论出生体重<1 500 g早产儿易发生UVC/PICC相关的心包积液, 多发生于置管后3 d内, 置管1周后易发生胸腔积液, 主要原因为管端异位, 置管后应动态超声检查监测管端位置, 以便及时纠正管端异位, 降低心包积液/胸腔积液发生风险。Objective:To analyze the clinical features,ultrasonic findings and treatment of pericardial effusion/pleural effusion associated with umbilical venous catheterization(UVC)and peripherally inserted central catheterization(PICC)in neonates.Methods:A retrospective analysis was conducted on the clinical data of neonates admitted to the neonatal intensive care unit of Gansu Maternal and Child Health Care Hospital from January 2022 to August 2024,who developed pericardial effusion/pleural effusion related to UVC/PICC.The clinical features,ultrasound findings,treatment and outcomes were summarized and analyzed.Results:During the study period,a total of 528 cases were performed,including 218(41.3%)PICC cases and 310(58.7%)UVC cases.Ten cases(1.9%)developed pericardial effusion/pleural effusion,including 7 cases in the UVC group and 3 cases in the PICC group,all of which were detected by bedside ultrasonography.Among the 10 cases,9 were preterm infants,6 were female,and 7 had a birth weight of<1500 g.All cases of pericardial effusion/pleural effusion were associated with catheter tip malposition.Six cases had the catheter tip located in the right atrium,one near the foramen ovale,two around the T2 vertebra,and one at the T9 vertebral level.The osmolarity of the infused fluid was 917.0(807.5,1011.3)mOsm,with medium-and long-chain lipid emulsion at 2.0(0.8,3.0)g/(kg·d),fluid volume at 120(80,140)ml/(kg·d),and the infusion rate at 5.0(3.3,5.8)ml/(kg·h).Pericardial effusion occurred in 7 cases,including 1 case with PICC and 6 cases with UVC.The effusion developed an average of 2.7 d after catheterization,and all cases presented with changes in heart rate and dyspnea.The venous catheter was removed in all cases,and pericardial puncture was performed in 4 cases.Pleural effusion occurred in 3 cases,including 1 case with UVC and 2 cases with PICC.The effusion developed an average of 9.0 d after catheterization,and all cases presented with sudden onset of dyspnea.The condition improved after catheter removal and thoracentesis.A

关 键 词：新生儿 心包积液 胸腔积液 脐静脉置管 经外周中心静脉置管 

分 类 号：R722.1[医药卫生—儿科]