经外周静脉穿刺中心静脉置管管末端影像学定位标志及个体相关因素分析

The radiology anatomical landmarks and individual factor of PICC catheter tip position

目的 :评估不同人群经外周静脉穿刺中心静脉置管(PICC)管末端位置的解剖定位及影响因素,提高置管的准确性。方法:回顾性分析100例PICC置入患者的胸部CT资料,分别测量并记录上腔静脉-右心房连接点(CAJ)与右锁骨胸骨端、气管隆突的垂直距离(分别为A1、A2值)及其与胸椎椎体高度的比值(V1、V2),分析性别、年龄、身高和BMI等个体因素对上述各值的影响。结果:A1为(94.93±20.33)mm,V1为4.10±0.78。A2为(38.71±14.9)mm,V1为4.10±0.78,V2为1.70±0.60;性别间A1、A2差异有统计学意义,年龄、身高对A1有显著影响,BMI对A1、A2值无显著影响,V1仅受年龄影响,而V2不受性别、年龄、身高、BMI等因素影响。结论:气管隆突可作为CAJ定位的可靠解剖标志,气管隆突下1.7个胸椎椎体位置为PICC管末端的合理位置。

Objective：To evaluate X-ray anatomical landmarks and influence factor of adult PICC catheter tip position for improving catheter tip veracity. Methods：100 patients who underwent CT scans were retrospectively included. The mean vertical distance of CAJ and the sternum of right clavicle（A1）,CAJ and carina（A2） was measured using vertebral body units（VBUs）（V1,V2）. What＇s more,statistics differences were studied in gender,height,age and BMI. Results：The mean vertical distance of CAJ and the sternum of right clavicle was（94.93±20.33）mm（about 4.1 in VBUs）,that of CAJ and carina was（38.71±14.9）mm（about 1.7 in VBUs）. A1,A2 and V1 had statistics difference in gender,age,height（P〈 0.05）;V2 was stable,there was no statistical difference in genders,age,height and IBM（P〉 0.05）. Conclusion：The influencing factors are obviously reduced by the VBUs that standardized by vertebral body. V2 is superior to V1（CAJ is below the carina in about 1.7 VBUs）. It is applicable and accurate that grasping those features to locate adult PICC tip.