两种PICC导管尖端定位方法的临床对照研究

A clinical controlled trial of two different PICC catheter positioning methods

目的比较PICC置管患者应用胸部X线摄片和全数字化彩色心血管超声诊断仪两种方法进行PICC导管尖端临床定位方法的一致性。方法选取2015年3月1日-12月31日就诊于天津医科大学总医院且需留置PICC的157例患者，采用同组自身对照法，即PICC置管时使用心血管超声确定导管尖端位置，置管结束后胸部X线摄片法再次确认。结果157例患者均成功置入PICC，胸部x线临床定位方法与心血管超声定位方法的相关性检验Spearman相关系数乍0．450（P〈0．001）；Pearson列联系数r=0．710（P〈0．001），两种定位方法具有相关性。一致性检验结果显示，三分类法K=0．390（P〈0．001）；二分类法K=0．707（P〈0．001），两种定位方法具有一致性。心血管超声定位方法的灵敏度为98．6％，ROC曲线下面积为0．917（P〈0．001），说明准确性较高。结论心血管超声可以作为临床上确定PICC导管尖端位置的一种方法，值得在临床中推广使用。

Objective To compare the consistency of two different peripherally inserted central catheters （PICC） catheter tip positioning methods of the chest X-ray and full digital color cardiovascular ultrasound diagnostic system in PICC patients. Methods A total of 157 cases of patients who underwent PICC catheterization in Tianjin Medical University General Hospital from 1st March to 31st December 2015 were selected. Self-control trial was applied, using full digital color cardiovascular ultrasound diagnostic system to determine the position of the catheter tip when implanting and using chest X-ray to reconfirm after catheterization. Results All 157 cases of patients were catheterized successfully. The correlation between the two methods of localization was tested, Spearman correlation coefficient rs=0.450 （P 〈 0.001）, Pearson serial number r=0.710 （P 〈 0.001）, showed that the two localization methods had certain relevance. The consistency test results showed that Kappa value was 0.390 （P 〈 0.001） in the three classification method, and Kappa value was 0.707 （P 〈 0.001） in the two classification method, and the two localization methods had certain consistency. The sensitivity of the cardiovascular uhrasound method was 98.6%, and the area under the ROC curve （AUC） was 0.917 （P 〈 0.001）, which showed a higher accuracy in cardiovascular ultrasound method. Conclusions Cardiovascular uhrasound can be used as another clinical method to determine the position of the PICC catheter tip, and it is worthy of promotion in clinical practice.