胸部X线和CT在PICC末端定位的一致性分析

Consistency analysis of chest radiographs and chest CT in PICC catheter terminal location

目的:探讨胸片(CXR)和胸部CT在评价经外周置入中心静脉导管(PICC)末端与气管隆嵴、右支气管角之间测量结果的一致性,提高PICC末端定位的准确性。方法:回顾性分析徐州医科大学附属医院83例PICC置管术后同一天内行CXR和CT检查的患者图像,分别测量并记录CXR和CT上PICC末端至气管隆突、右支气管角的垂直距离,采用Bland-Altman方法分析两种测量方法的一致性。胸部CT上测量气管隆突至上腔静脉与右心房交界处(CAJ)的垂直距离。结果:CXR组和CT组PICC末端-气管隆突的距离分别为(36.7±17.5)m m、(31.7±18.2)m m,CXR组和CT组PICC末端-右支气管角的距离分别为(40.0±18.5)m m、(33.5±18.1)mm。胸部CT测量气管隆突-CAJ的距离为(42.7±10.8)mm,且男性大于女性,差异具有统计学意义(P<0.05)。结论:CXR和胸部CT评价PICC末端至气管隆突、右支气管角的距离具有一致性。以气管隆突为PICC末端定位标志时,应考虑患者性别因素。

Objective To investigate the consistency of chest X-ray(CXR)and chest CT measurements in localizing the tip of peripherally inserted central venous catheter(PICC),and improve the accuracy of PICC tip location.Methods 83 patients who underwent CXR and chest CT examination on the same day after PICC catheterization were retrospectively analyzed.The vertical distance from the tip of PICC to tracheal carina,distance from the tip of PICC to right bronchial angle on CXR and CT were measured and recorded,respectively,and the consistency of the measurement results of the two methods was analyzed.The vertical distance between the tracheal carina and the cavoatrial junction(CAJ)was measured on chest CT.Results The mean distance between PICC tip and tracheal carina was(36.7±17.5)mm in the CXR group and(31.7±18.2)mm in the CT group.The mean distance between PICC tip and right bronchial angle was(40.0±18.5)mm in the CXR group and(33.5±18.1)mm in the CT group.The mean distance between tracheal carina and CAJ was(42.7±10.8)mm,which was larger in males than in females,and the difference was statistically significant.Conclusion The distance from the tip of the PICC to tracheal carina and right bronchial angle measured on chest radiography were slightly higher than that on chest CT.When carina is used as a marker of PICC terminal location,the gender of patients should be considered.