超声引导下新生儿脐静脉置管术后管尖发生移位的影响因素

Risk factors for catheter tip displacement after ultrasound-guided umbilical vein catheterization in neonates

目的早产儿在行超声引导下新生儿脐静脉置管术(UVC)后可出现管夹位移而影响疗效。文中探讨影响其发生的危险因素。方法选取2015年1月至2017年6月东莞市妇幼保健院床旁超声引导下行UVC置管术的159例患儿,统计一次性置管成功率,并对置管成功患儿进行监测。根据置管后7 d管尖是否移位分为移位组和未移位组,收集2组患儿可疑危险因素,采用单因素和多因素Logistic回归分析探究影响UVC管尖移位危险因素。结果 159例患儿在超声引导下行UVC置管术,一次性置管成功106例(66.67%)。106例置管成功患儿于置管7 d后行超声和X线胸腹片检查,87例(82.07%)患儿导管管尖未发生移位,19例(17.93%)患儿导管管尖发生移位,其中管尖位置上升5例(4.72%)、管尖位置下降14例(13.21%)。2组间胎龄、体重、导管外固定方式、躁动、针对导管照护时间、脱管比较,差异有统计学意义(P<0.05)。多因素分析得出,胎龄(OR=-1.315,P=0.015)、体重(OR=-1.214,P=0.019)、导管外固定方式(OR=2.164,P=0.007)、躁动(OR=1.354,P=0.014)、针对导管照护时间(OR=1.458,P=0.012)、脱管(OR=2.016,P=0.010)为影响UVC置管术术后管尖移位发生危险因素。结论超声引导下UVC置管术后发生管尖移位影响因素众多,临床中根据相关危险因素实施预防对降低管尖移位发生率具有重要临床意义。

Objective Catheter tip displacement（ CTD） after ultrasound-guided umbilical vein catheterization（ UVC） in neonates may influence the effect of treatment. This study was to investigate the risk factors for CTD. Methods This study included159 neonates undergoing ultrasound-guided UVC in our hospital between January 2015 and June 2017. We recorded the one-time success rate of UVC and the numbers of cases of CTD and non-CTD at 7 days after UVC,and analyzed the risk factors for CTD by univariate and multivariate logistic regression analyses. Results Ultrasound-guided UVC was successfully performed in 106（ 66. 67%） of the neonatal patients,who underwent ultrasonography and thoracic and abdominal X-ray examinations 7 days later. CTD was observedin 19（ 17. 93%） of the 106 neonates,including 5 cases of upward shift（ 4.72%） and 14 cases of downward shift（ 13.21%）,while the other 87（ 82. 07%） were non-CTD cases. Statistically significant differences were found between the CTD and non-CTD groups in the gestational age,body mass,catheter external fixation,restlessness,catheter-tending time,and catheter shifting（ P〈0.05）. Multivariate analysis showed that the gestational age（ OR =-1. 315,P = 0. 015）,body mass（ OR =-1.214,P = 0.019）,catheter external fixation（ OR = 2. 164,P = 0. 007）,restlessness（ OR = 1. 354,P = 0. 014）,catheter-tending time（ OR = 1.458,P = 0.012）,and catheter shifting（ OR = 2.016,P = 0.010） were the risk factors for CTD after ultrasound-guided UVC. Conclusion There are quite a few risk factors for CTD after ultrasound-guided UVC,which can be reduced by relevant preventive measures.