经食管超声技术指导婴幼儿中心静脉置管的临床应用

Use of Transesophageal Echocardiography in Determining Optimal Depth of Central Venous Catheter in Infants

【目的】探讨经食管超声技术(TEE)在指导婴幼儿中心静脉导管定位的可能性及临床应用价值。【方法】选择择期行心血管手术的婴幼儿100例,其中53例采用经食管超声技术定位中心静脉导管置入的深度,47例依据身高、年龄以及体重确定中心静脉导管的置入深度,并对两组胸部X线平片中管尖所在的相应胸椎水平进行比较。【结果】所有中心静脉导管经TEE引导后管尖的位置均能准确的定位于第四胸椎(T4)与第六胸椎(T6)水平之间,相当于上腔静脉与右心房的连接处。未经TEE定位组中心静脉导管的管尖则广泛分布于T3与T8之间。【结论】TEE可以为婴幼儿中心静脉管的定位提供一个客观、直接的定位标准。

[Objective] To examine the use of transesophageal echocardiography in determining optimal depth of insertion of CVP catheter in infants undergoing cardiovascular surgery. [ Methods ] A total of 100 infants undergoing cardiovascular surgery were selected. In 53 cases,the CVP catheterization was performed with the guide of TEE, the other 47 cases were performed based on the body weight, height and age of the infants, The position of the tip of the catheter determined by Anterior-Posterior chest X-ray,was identified by the level of thoracic vertebra （Tx）. [Results] The position of tip guided by TEE was normally distributed from T4-T6 which anatomically corresponds to the connection of SVC and right atrium. But in non-TEE group the position of tip was broadly distributed from T3-T8. [Conclusion] TEE is a simple and accurate guide for placement of the tip of the catheter at T4-T6 level in infants.