陈晓春 陈赢赢 童燕芬 朱聪

[摘要] 目的 探讨床旁超声心动图导管尖端定位在减少新生儿PICC置管异位中的应用。 方法 选取2018年5月至2019年5月我院140例PICC置管的新生儿，随机分为观察组与对照组，每组各70例，观察组送管成功后先行床旁超声心动图定位，置管结束后再床旁X线胸腹摄片定位;对照组只在置管结束后行床旁X线胸腹摄片定位。比较两组置管一次性到位率、原发性导管异位率、成功置管率、X线暴露次数、非计划性拔管率和并发症发生情况。结果 观察组置管一次性到位率、成功置管率明显高于对照组（P<0.01），原发性导管异位率、非计划性拔管率和并发症总发生率均明显低于对照组（P<0.01与P<0.05），观察组X线暴露次數也明显少于对照组（P<0.05）。 结论 超声心动图导管尖端定位可及时发现导管异位并及时纠正，降低导管异位率及相关并发症发生率，而且操作简便、动态显示、随时定位，可减少X线暴露。床边超声心动图尖端定位不仅可使用于置管过程中，而且在导管使用过程中也可随时床边跟踪定位，获取尖端位置的实时信息，以便及早发现异位并及时做出应对措施。

[关键词] 导管插入术;外周;超声;定位;新生儿

[中图分类号] R473.72          [文献标识码] B          [文章编号] 1673-9701（2021）07-0123-05

Application of catheter tip positioning by bedside echocardiography in reducing neonatal ectopic PICC catheterization

CHEN Xiaochun   CHEN Yingying   TONG Yanfen   ZHU Cong

Neonatal Department， Second Affiliated Hospital of Wenzhou Medical University， Wenzhou   325000， China

[Abstract] Objective To explore the application of bedside echocardiography catheter tip positioning in reducing neonatal PICC catheter ectopic. Methods A total of 140 neonates with PICC in our hospital from May 2018 to May 2019 were randomly divided into an observation group and a control group， with 70 cases in each group. The bedside echocardiography after successful tube delivery was first performed in the observation group. After the end of the tube placement， the bedside X-ray chest and abdomen radiographs were performed for positioning. In the control group only X-ray chest and abdominal radiographs were performed for positioning after tube placement. The differences between the two groups were compared in terms of the rate of one-time catheter placement， primary catheter ectopic rate， successful catheter placement rate， number of X-ray exposures， unplanned extubation rate， and complications. Results The one-time placement rate and successful tube placement rate of the observation group were significantly higher than those of the control group（P<0.01）， the occurrence of primary catheter ectopic rate， unplanned extubation rate and total incidence of complications was significantly lower than that of the control group（P<0.01 and P<0.05）， and the number of X-ray exposure in the observation group was also significantly less than that of the control group（P<0.05）. Conclusion Echocardiographic catheter tip positioning can promptly find and correct ectopic catheter， reduce the ectopic rate of catheter and related complications. It is easy to operate， with dynamic display， localization at any time， and can reduce X-ray exposure. Bedside echocardiographic tip positioning can be used not only during tube placement， but also at bedside tracking and positioning at any time during catheter use， to obtain real-time information on the position of the tip， in order to detect ectopics early and make timely response measures.

[Key words] Catheterization; Peripheral; Ultrasound; Positioning; Newborn

经外周静脉置入中心静脉导管（Peripherally inserted central catheters，PICC）以其独特的优点在新生儿科广泛应用，但置管过程中易发生导管异位[1]。导管异位是新生儿PICC并发症和危险性发生的最主要原因[2]，可导致液体渗漏、肢体肿胀、疼痛等，也可发生一些特殊的危险，如血流感染、栓塞、胸膜腔渗出、心包积液、心房颤动等[3-4]，一旦处理不當，不仅影响其治疗效果，严重者危及生命。临床上导管异位一般拔除导管或调整尖端位置后当外周静脉使用，必要时重新置管，不仅增加患儿的痛苦与护理人员的工作量，而且重新置管可增加感染的风险，造成价格昂贵的PICC导管浪费，增加医疗费用。因此，为了降低导管异位，提高置管成功率，我院新生儿科开展床旁超声心动图PICC导管尖端定位，探讨超声尖端定位对减少PICC异位的效果，现报道如下。……