经胸超声心动图在血液透析患者带隧道和涤纶套的透析导管尖端定位中的价值:1项单中心前瞻性研究  

The value of transthoracic echocardiography to locate the tip of tunnel cuffed central venous catheter in hemodialysis patients:a single-center prospective study

作　　者：张萌 李露 段书众[2] 刘会玲[1] ZHANG Meng;LI Lu;DUAN Shu-zhong;LIU Hui-ling(Department of Ultrasound Medicine,The Affiliated Hospital of Chengde Medical College,Chengde 067000,China;Department of Nephrology,The Affiliated Hospital of Chengde Medical College,Chengde 067000,China)

机构地区：[1]承德医学院附属医院超声医学科,承德067000 [2]承德医学院附属医院肾内科,承德067000

出　　处：《中国血液净化》2025年第4期308-312,共5页Chinese Journal of Blood Purification

基　　金：承德市科学技术研究与发展计划项目(202006A058)。

摘　　要：目的比较经胸超声心动图(transthoracic echocardiography,TTE)和胸部X射线(chest X-ray,CXR)识别带隧道和涤纶套的透析导管(tunnel-cuffed catheter,TCC)尖端的诊断价值。方法纳入2021年2月—2022年12月在承德医学院附属医院行血液透析且需要TCC置管的患者,置管手术前收集人口学资料,置管手术后分别使用TTE、CXR和计算机断层扫描(computerized tomography,CT)确定TCC的尖端位置。以CT结果为参照,计算TTE和CXR定位导管尖端的敏感性、特异性、误诊率、漏诊率、阳/阴性似然比。采用卡方检验分析TTE和CXR与CT的一致性。ROC曲线分析不同诊断方法的真实性。结果共纳入164例血液透析患者。TTE的诊断敏感性、特异性、阳性预测值(0.972,0.923,12.132)均高于CXR(0.900,0.424,1.553),误诊率和漏诊率(0.082,0.034)均低于CXR(0.584,0.100)。TTE和CT的诊断一致性(Kappa=0.896,χ^(2)=0.068,P=0.727)高于CXR(Kappa=0.357,χ^(2)=13.457,P<0.001)。TTE的诊断真实性(AUC=0.984,95%CI:0.959~1.000,P<0.001)高于CXR(AUC=0.794,95%CI:0.714~0.873,P<0.001)。结论TTE较CXR更适合定位TCC尖端位置。Objective To compare the diagnostic value of transthoracic echocardiography(TTE)and chest X-ray(CXR)in identifying tip position of tunnel cuffed central venous catheter(TCC).Method Patients who underwent hemodialysis and used TCC for blood access at The Affiliated Hospital of Chengde Medical College from February 1,2021 to December 31,2022 were recruited as the research subjects.Demographic data was collected before and after the catheterization.TTE,CXR,and computerized tomography(CT)were used to determine the tip position of TCC,and CT result was used as the reference.The sensitivity,specificity,misdiagnosis rate,missed diagnosis rate,and positive/negative likelihood ratio for catheter tip localization by TTE and CXR were calculated.Chi square test was used to analyze the consistency between TTE,CXR and CT.ROC curve was used to evaluate the validity of different diagnostic methods.Results A total of 164 hemodialysis patients were included in the study.The diagnostic sensitivity,specificity and positive predictive values were 0.972,0.923 and 12.132 respectively for TTE method,higher than the values of 0.900,0.424 and 1.553 respectively for CXR method.The misdiagnosis and missed diagnosis rates were 0.082 and 0.034 respectively for TTE method,lower than the values of 0.584 and 0.100 respectively for CXR method.The diagnostic consistency between TTE and CT was higher than that between CXR and CT(TTE/CT:Kappa=0.896,χ^(2)=0.068 and P=0.727;CXR/CT:Kappa=0.357,χ^(2)=13.457,P<0.001).The diagnostic accuracy of TTE was higher than that of CXR(TTE:AUC=0.984,95%CI:0.959~1.000,P<0.001;CXR:AUC=0.794,95%CI:0.714~0.873,P<0.001).Conclusion TTE is better than CXR for localization of the TTC tip.

关 键 词：血液透析 导管异位 经胸超声心动图 尖端定位 

分 类 号：R459.5[医药卫生—治疗学]