比较两种预测小儿中心静脉导管置管深度方法——高度公式引导法与胸骨角引导法

Comparison of Two Methods for Predicting the Depth of Central Venous Catheter Placement in Pediatric Patients⁃Height Formula⁃guided and Sternal Angle⁃guided

目的:比较高度公式引导法与胸骨角引导法预测小儿中心静脉导管(CVC)置管深度方法的效果差异。方法:回顾性分析2014年1月至2021年1月接受右颈内静脉导管术205例的儿童资料,使用胸骨角引导(S组)101例,使用高度公式引导(H组)104例。比较两组人口统计学特征、导管尖端到心尖的距离、CVC尖端和心尖的相对位置、术后相关并发症及尖端位置的术后调整。结果:与H组相比,S组的CVC头端到心窝的垂直长度明显浅(-8.93±6.41 mm vs.3.76±13.35 mm,P<0.001),且CVC头端高于心窝的数量更多(98.0%vs.47.1%,P<0.001)。在S组中无患儿需要在术后调整CVC位置,也无并发症发生。H组术后需要调整CVC位置4例,其中与CVC相关的心律失常3例,导管功能障碍1例。结论:胸骨角引导法可能是比高度公式引导法预测小儿中心静脉置管深度更安全的方法。

Objectives:To compare the difference in effectiveness between the height formula guidance method and the sternal angle guidance method in predicting the depth of pediatric central venous catheter(CVC)placement meth⁃ods.Methods:Data from 205 children who underwent right internal jugular vein catheterization from January 2014 to January 2021 were retrospectively analyzed,101 using sternal angle guidance(group S)and 104 using height formula guidance(group H).Demographic characteristics,catheter tip⁃to⁃tip distance,relative position of the CVC tip and tip,postoperative complications associated with the procedure,and postoperative adjustment of tip position were compared between the two groups.Results:Compared with group H,group S had a significantly shallower vertical length of the CVC tip to the apical fossa(-8.93±6.41 mm vs.3.76±13.35 mm,P<0.001)and a greater number of CVC tips above the apical fossa(98.0%vs.47.1%,P<0.001).No children required postoperative repositioning of the CVC and no complica⁃tions occurred in group S.There were 4 cases of postoperative repositioning of the CVC in group H,including 3 cases of CVC⁃related arrhythmias and 1 case of catheter dysfunction.Conclusion:Sternal angle guidance may be a safer method than height formula guidance for predicting the depth of pediatric central venous catheterization.