床旁超声在重症新生儿中心血管通路装置尖端定位的应用效果和价值

Effect and value of bedside ultrasound in the tip localization of central vascular pathway device in severe neonates

目的探究和分析床旁超声在重症新生儿中心血管通路装置尖端定位中的应用效果和价值。方法从2018年10月到2019年7月期间玉林市第一人民医院新生儿重症病房中选取其中82例实施中心血管通路置管的早产儿作为本次临床试验研究的观察与分析对象,按照数字随机法将这82例患儿分为对照组与观察组两组,两组各41例。对照组患儿实施X线胸片引导定位,观察组患儿实施床旁超声引导定位。比较对照组与观察组两组患儿尖端定位的清晰显示率、尖端定位的准率。观察两组患儿经外周静脉置入中心静脉导管(peripherally inserted central venous catheters,PICC)在上肢或下肢的外展和内收状态下移位的幅度。比较两组患儿经手法复位后尖端准确回位的成功率。结果观察组患儿在尖端定位的清晰显示率高于对照组,差异有统计学意义(92.68%vs.51.22%,P<0.05)。观察组患儿的手法复位后PICC回位成功率比对照组高,差异有统计学意义(100%vs.66.6%,P<0.05)。观察组患儿肢体内收和外展时的PICC移位幅度平均为2.5 mm;对照组患儿的PICC移位幅因患儿不能连续拍片而未能测量。结论将床旁超声应用到重症新生儿中心血管通路装置的尖端定位中,能够显著提高尖端定位的清晰显示率、准确定位率、观察异位尖端经辅助手法复位后的成功率。

Objectives To explore and analyze the effect and value of bedside ultrasound in the tip localization of cen⁃tral vascular pathway device in severe neonates.Methods From October 2018 to July 2019,82 premature infants with central vascular pathway catheterization were selected as the objects of observation and analyzed in this clinical trial.According to the digital random method,the 82 children were divided into control group(n=41)and observation group(n=41).The children in control group were guided by X-ray chest radiography,and the children in observation group were guided by bedside ultrasound.The clear display rate and the accuracy rate of tip localization were compared between control group and observation group.The displacement of peripherally inserted central venous catheters(PICC)in upper limb or lower extremity was observed.The success rate of accurate localization of tip after manual reduction was compared between the two groups.Results The clear display rate of the tip localization in observation group was significantly higher than that in control group(92.68%vs.51.22%,P<0.05).The success rate of PICC return after the manual reduction of the children in observation group was significantly higher than that in control group(100%vs.66.6%,P<0.05).The average amplitude of PICC shift in the limbs of observation group was 2.5 mm.The PICC shift amplitude of control group could not be measured because the children could not continuously film.Conclusions The application of bedside ultrasound to the tip localization of central vascular pathway device in severe neonates can significantly improve the clear display rate,accurate localization rate and success rate of PICC return after the manual reduction of tip localization.