多探头联合超声在引导儿童PICC尖端定位的临床应用研究

The Clinical application study of joint ultrasound with multi-probe in guiding the PICC tip location for children

目的探讨多探头联合超声在引导儿童经外周静脉置入中心静脉导管(peripherally inserted central venous catheters,PICC)尖端定位的临床应用价值。方法选取2019年7月~12月我院收治的PICC穿刺术168例患儿分为对照组和实验组。对照组行常规PICC置管术,术后X线摄影评估导管尖端定位准确性。实验组采用多探头联合超声引导PICC置管全程,并对术后导管尖端定位进行评估。PICC首次尖端定位不理想者进行二次调整,且再次评估尖端定位准确率。比较两组患儿PICC首次和二次尖端定位准确率、导管异位及术后并发症情况。结果实验组PICC尖端定位首次准确率明显高于对照组(P<0.05);实验组PICC尖端定位不理想者13例,其中位置过深8例,过浅3例,异位2例,对照组PICC尖端定位不理想者27例,其中位置过深19例,过浅5例,异位3例,实验组导管位置过深和术后并发症的发生率明显低于对照组(P<0.05);首次尖端定位不理想者经二次调整后准确率均为100%。结论多探头联合超声不仅能引导PICC置管术全过程,明显提高一次性尖端定位准确率,还能降低患儿术后并发症的发生率。

Objective To explore the clinical application value of joint ultrasound with multi-probe in guiding the PICC(peripherally inserted central venous catheters)tip location.Methods 168 children who underwent PICC puncture in our hospital from July to december 2019 were divided into control group and experimental group.The control group underwent traditional PICC catheterization,the accuracy of catheter tip location was evaluated by X-ray radiography after puncture.The whole PICC process of experimental group was guided by joint ultrasound with multi-probe and evaluated the location of catheter tip after puncture.The catheter tip location of children whose tip location was unsatisfactory for the first time was adjusted again and reevaluated the accuracy of tip location.We compared the accuracy rate of one-time and two-time of PICC tip location,the situation of catheterd ectopia and postoperative complications between two groups.Results The accuracy rate of one-time PICC tip location of the experimental group was significantly higher than that of the control group(P<0.05).In experimental group,the PICC tip location of 13 cases was not unsatisfactory.Among them,the location of 8 cases was too deep,the location of 3 cases was too shallow,the location of 2 cases was ectopic.In control group,the PICC tip location of 27 cases was not unsatisfactory.Among them,the location of 19 cases was too deep,the location of 5 cases was too shallow,the location of 3 cases were ectopic;and the incidence of excessive deep catheter location and postoperative complications in experimental group was significantly lower than that of control group(P<0.05).The accuracy rate of children whose one-time PICC tip location was unsatisfactory was 100%after the second adjustment.Conclusion The joint ultrasound with multi-probe not only guides the whole PICC process and significantly improves the accuracy rate of one-time tip location,but also can reduce the incidence of postoperative complications of children.