适于胎龄与小于胎龄的极低出生体重儿身长增长对PICC尖端移位的影响及比较

The effect of grouth in length on PICC tip displacement in very low birth weight infants appropriate for gestational age and less than gestational age

目的探讨极低出生体重儿(very low birth weight,VLBW)中适于胎龄儿(appropriate for gestational age,AGA)和小于胎龄儿(small for gestational age,SGA)身长增长对经外周中心静脉置管(peripherally inserted central catheter,PICC)尖端移位的影响,并横向比较影响程度,帮助医护人员更好地把握导管尖端位置监测的时机。方法回顾性分析2021年1月—2022年6月在医院NICU住院并使用PICC的VLBW,按出生体质量和胎龄关系分为AGA组45例和SGA组19例,记录首次置管当日身长(Ht_(1))以及PICC尖端位置、置管期间胸片检查当日身长(Ht_(n))以及PICC尖端位置,并计算相应的身长增长率。身长增长率与PICC尖端移位的相关性用Spearman秩相关分析。将AGA和SGA的身长增长率分别与PICC尖端移位进行简单线性回归分析,构建回归模型,用协方差分析比较两组回归直线。结果VLBW中AGA组97.8%患儿出现移位,SGA组所有的患儿都出现移位,占比最多的均为移位3个椎体。Spearman秩相关分析结果显示,两组患儿身长增长率与PICC尖端移位均具有相关性(AGA组rs=-0.719,P<0.001;SGA组rs=-0.769,P<0.001),随着VLBW身长增长,PICC尖端逐渐移位远离心脏。简单线性回归分析结果显示,AGA组回归模型(R^(2)=0.517,调整后R^(2)=0.513,F=129.487,P<0.001),SGA组回归模型(R^(2)=0.591,调整后R^(2)=0.585,F=95.385,P<0.001)。协方差分析结果显示,由于回归系数检验没有统计学意义,两条直线平行,说明身长增长率对两组患儿位移的影响一致。截距比较有统计学意义(F=9.265,P=0.003),说明两组患儿位移的起点不同(即增长率为零时的位移位置),说明位移与是否为AGA、SGA有关。结论随着VLBW中AGA和SGA身长增长,PICC尖端逐渐移位远离心脏,但相同的身长增长率,SGA引起的导管尖端移位幅度更大。建议AGA身长增长率12.4%、SGA身长增长率9.5%可作为监测导管尖端位置的重要时机,以免导管尖端进一步移位至非中心静脉,导致相关并发症发生。

Objective To investigate the influence of body length growth on PICC tip displacement in appropriate for gestational age infants(AGA)and younger gestational age infants(SGA)among very low birth weight infants,to compare the extent of the impact laterally to help better grasp the timing of catheter tip position monitoring.Methods A retrospective analysis was conducted of VLBW by using PICC hospitalized in NICU from January 2021 to June 2022.The VLBW were divided into 45 cases in the AGA group and 19 cases in the SGA group based on the relationship between birth weight and gestational age.The body length(Ht_(1))and the position of PICC tip on the day of initial catheterization,the body length(Ht_(n))and the position of the PICC tip on the day of chest radiograph during catheterization were recorded,and the corresponding body length growth rate was calculated.The correlation between body length growth rate and PICC tip displacement was analyzed using by Spearman rank correlation analysis.Perform a simple linear regression analysis between the body length growth rate of AGA and SGA and the PICC tip displacement respectively,to construct regression models,and use covariance analysis to compare the two sets of regression lines.Results In VLBW,the vast majority of children(97.8%)in the AGA group experienced displacement,while all children in the SGA group experienced displacement,with the largest proportion of 3 vertebral bodies displaced.Spearman rank correlation analysis showed that there was a correlation between body length growth rate and PICC tip displacement in both groups(AGA group rs=-0.719,P<0.001;SGA group rs=-0.769,P<0.001).As VLBW body length increased,PICC tip displacement gradually moved away from the heart.The results of simple linear regression analysis showed that the AGA group regression model(R^(2)=0.517,adjusted R^(2)=0.513,F=129.487,P<0.001),the SGA group regression model(R^(2)=0.591,R^(2)=0.585,F=95.385,P<0.001).As the regression coeffcient test was not statistically significant,the two lines were parallel,indicating that the growth rate of length had a consistent effect on the displacement of the children in both groups,the comparison of intercepts was statistically significant(F=9.265,P=0.003),It shows that the starting point of displacement in the two groups of the infants(the location of displacement when the growth rate was zero),indicating that it is relevant whether the displacement is AGA and SGA.Conclusion As the body length of AGA and SGA in VLBW increases,the PICC tip gradually shifts away from the heart,but with the same body length growth rate,SGA causes greater catheter tip displacement.Clinically,the AGA body length growth rate of 12.4%and the SGA body length growth rate of 9.5%were important opportunities to monitor the position of the catheter tip to avoid further displacement of the catheter tip to the non-central venous,leading to related complications.