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外周置入的中心静脉导管与中心静脉置管在重症监护病房患者中心静脉压监测中的效果相当。

Peripherally inserted central catheters are equivalent to centrally inserted catheters in intensive care unit patients for central venous pressure monitoring.

机构信息

Division of Pulmonary and Critical Care Medicine, TheUniversity of Kansas Medical Center, 3901 Rainbow Blvd,MS 3007, Kansas City, KS 66160, USA.

出版信息

J Clin Monit Comput. 2012 Apr;26(2):85-90. doi: 10.1007/s10877-012-9337-1.

Abstract

To determine the equivalency of pressure measurements from peripherally inserted central catheters(PICCs) versus centrally inserted central venous catheters(CVCs) in vitro as well as in vivo. The in vitro study was performed in a clinical laboratory. Static pressure measurements from PICCs and CVCs were obtained in vitro over a physiologic range of 5–25 mmHg. Triple and dual lumen PICCs were directly compared to CVC controls.Dynamic pressure waveforms were recorded to simulate physiologic intravascular pressure variation. The in vivo study was executed in the medical intensive care unit(MICU) of a tertiary-level academic medical center. Data was collected from ten adult patients with both a PICC and a CVC in place for on-going clinical care. Measurements of central venous pressure (CVP) were recorded simultaneously from PICCs and CVCs. Duplicate measurements were taken after a stable waveform was recorded. For the in vitro study, a total of 540 pressure measurements were recorded. The average bias determined by Bland–Altman plot was 0 mmHg for the 5Fr PICC and 0.071 mmHg for the 6Fr PICC. The correlation coefficient for both catheters was 1.0 (P<0.001). Dynamic pressure waveforms revealed equivalent amplitude. During the in vivo trial, 70CVP measurements were collected. The paired CVP measurements were found to be highly reliable across subjects (r = 0.99, P<0.0001). No significance in the average difference in CVP measurement (PICC–CVC) was determined by the Wilcoxon Signed Rank test (S = 1,P = 0.93). In conclusion, PICCs are equivalent to CVCs when measuring static and dynamic pressure in vitro and CVP in ICU patients.

摘要

目的

确定外周静脉置入中心静脉导管(PICC)与中心静脉导管(CVC)在体外和体内测量压力的等效性。

体外研究在临床实验室进行。在 5-25mmHg 的生理范围内,对 PICC 和 CVC 进行静态压力测量。直接将三腔和双腔 PICC 与 CVC 对照进行比较。记录动态压力波形以模拟生理血管内压力变化。

体内研究在三级学术医疗中心的医疗重症监护病房(MICU)进行。从正在接受临床治疗的 10 名成人患者中收集了 PICC 和 CVC 并存的数据。同时从 PICC 和 CVC 记录中心静脉压(CVP)的测量值。在记录到稳定的波形后,重复进行两次测量。

在体外研究中,共记录了 540 次压力测量值。Bland–Altman 图确定的平均偏差为 5Fr PICC 为 0mmHg,6Fr PICC 为 0.071mmHg。两种导管的相关系数均为 1.0(P<0.001)。动态压力波形显示出等效的幅度。

在体内试验中,共收集了 70 次 CVP 测量值。通过配对 CVP 测量值,在研究对象中具有高度可靠性(r=0.99,P<0.0001)。Wilcoxon 符号秩检验(S=1,P=0.93)未确定 CVP 测量(PICC-CVC)的平均差异有统计学意义。

结论

在体外测量静态和动态压力以及 ICU 患者的 CVP 时,PICC 与 CVC 等效。

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