两种耐高压型经外周静脉穿刺置入中心静脉导管尖端定位技术临床对照研究

Clinical comparative study of two high pressure resistant peripherally inserted central catheter tip positioning techniques

目的比较基于CT和C型臂X线(CX)的两种耐高压型经外周静脉穿刺置入中心静脉导管(HPR-PICC)尖端定位技术。方法选取2018年6月-2021年9月于河北北方学院附属第一医院放疗科接受诊疗的胸部肿瘤患者101例。采用自身对照法,比较基于CT和CX的HPR-PICC尖端定位的图像质量、异位检出能力和影像学距离一致性。结果85例(84.16%)患者CT图像上HPR-PICC尖端完全显示,14例(13.86%)不完全显示,2例(1.98%)完全不显示;54例(53.47%)患者CX图像上HPR-PICC尖端完全显示,39例(38.61%)不完全显示,8例(7.92%)完全不显示。排除掉尖端完全不显示的患者后,剩余患者中CT技术总异位检出率和右心系统异位检出率均高于CX技术(P<0.05)。进一步排除掉尖端不完全显示的患者后,CT图像上右肺门-上腔静脉与右心房连接处距离为(8.351±5.262)mm,CX图像为(8.497±5.731)mm,一致性较好;CT图像上右肺门-尖端距离为(8.012±4.978)mm,CX图像为(8.331±5.395)mm,一致性较好。结论HPR-PICC尖端定位中CT图像质量和异位检出能力均显著优于CX图像,两种图像上影像学距离一致性较好,CT可取代X线作为金标准。

Objective To compare two kinds of highpressure resistant peripherally inserted central catheter(HPR-PICC)tip positioning techniques based on CT and C-arm X-ray(CX).Methods 101 tumor patients who met the inclusion-exclusion criteria were selected.Image quality,ectopic detection ability and imaging distance consistency of HPR-PICC tip positioning based on CT and CX were compared by using self-control method.Results The tip of HPR-PICC was completely displayed on CT image for 85(84.16%)patients,14(13.86%)was incompletely displayed,and 2(1.98%)was not displayed.The tip of HPR-PICC was completely displayed on CX image for 54(53.47%)patients,39(38.61%)was incompletely displayed,and 8(7.92%)did no appear After excluding patients whose tips were not displayed,the ectopic total detection rate and right cardiac system ectopic detection rate in the remaining patients with CT technology were higher than that with CX technology(P<0.05).After further excluding patients whose tips were incomplete displayed,the distance between the right hilar and caval-atrial junction was(8.351±5.262)mm on CT images and(8.497±5.731)mm on CX images,with fairly good consistency.The distance between the right hilar and tip was(8.012±4.978)mm on CT images and(8.331±5.395)mm on CX images,with fairly satisfactory consistency.Conclusion CT image quality and ectopic detection ability was significantly better than CX images in HPR-PICC tip positioning.Consistency of imaging distance on the two images was fairly good,and CT could replace X-ray as the gold standard.