基于体表标志估算静脉输液港导管置入长度的新方法

A new method for estimating catheter length of implantable central venous port based on body surface marker

目的:分析右侧颈内静脉输液港导管置入长度的影响因素,并建立基于右侧胸骨第三肋间隙作为解剖标志测量导管长度的回归方程。方法:收集西安交通大学第一附属医院2017年9月至2018年7月行右侧颈内静脉植入式输液港的患者共190例为研究对象,均采用术中透视确定导管长度,并记录穿刺部位至右侧胸骨第三肋间隙的距离(SK-ICS)。采用Pearson相关分析法分析实际置管长度与患者的年龄、身高、体质量、体质指数(body mass index,BMI)及SK-ICS的相关性,通过多元线性回归分析建立回归方程,并与其余3种常用公式进行对比。结果:导管长度与患者的身高、体质量及SK-ICS值存在正相关(P<0.05),与BMI呈负相关(P<0.05)。通过多元线性回归分析得到回归方程:L=1.01×SK-ICS+0.151。该方程估算值与实际长度相比无明显差异(P>0.05),而其余3种公式估算值均长于实际值。回归方程的绝对误差与百分比值均较低,预测置管长度准确性较高。结论:通过使用体表标志建立的回归方程对导管长度的估算具有一定的临床指导价值和推广意义。

Objective:To analyze the influencing factor of catheter placement length in totally implantable central venous port(TICVP) via right internal jugular vein,and to establish a regression equation based on the right third intercostal space as an anatomical landmark to measure the length of the catheter. Methods:A total of 190 patients with right internal jugular vein TICVP in First Affiliated Hospital of Xi’an Jiaotong University from September 2017 to July 2018 were collected. Intraoperative fluoroscopy was used to determine the length of the catheter and the distance from the puncture site to the right third intercostal space(SK-ICS) was recorded. Pearson correlation analysis was used to analyze the correlation between the actual catheter length and the patients’ age,height,weight,BMI and SK-ICS. The regression equation was established by multiple linear regression analysis and other three commonly used formulas were used to compare. Results:Catheter length had a positive correlation with patients’ height,weight and SK-ICS(P<0.05),while had a negative correlation with BMI(P<0.05). The regression equation of L=1.01×SK-ICS+0.151 was obtained through multiple linear regression analysis. The estimated value of the equation had no significant difference compared with the actual length(P >0.05),while the other three formulas were longer than the actual value. The absolute error and percentage value of the regression equation were relatively lower,with higher accuracy for predicting catheter length. Conclusion:The regression equation established by the surface anatomical landmark has certain clinical guiding values and promotion significance for the estimation of catheter length.