对比增强超声与胸部 X 射线在确定中心静脉导管位置中的比较。

Contrast enhanced ultrasound vs chest x-ray to determine correct central venous catheter position.

机构信息

Unità Operativa di Pronto Soccorso e Medicina D'urgenza, Dipartimento di Emergenza e Urgenza, Ospedale Maggiore Niguarda, Milano, Italy.

出版信息

Am J Emerg Med. 2014 Jan;32(1):78-81. doi: 10.1016/j.ajem.2013.10.001. Epub 2013 Oct 9.

DOI:10.1016/j.ajem.2013.10.001

PMID:24184012

Abstract

PURPOSES

We aimed to analyze the diagnostic accuracy of contrast enhanced ultrasonography (CEUS), compared with chest x-ray (CXR), in the detection of correct central venous line (CVL) placement. Our hypothesis was to verify whether CEUS could substitute CXR as a reference standard for correct placement of CVL or function as a triage test to limit the execution of CXR only for selected patients.

BASIC PROCEDURES

CEUS was carried out in 71 non consecutive patients to verify the correct positioning of a central venous line. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios of CEUS compared to CXR, with their respective 95% confidence interval (CI), were calculated.

MAIN FINDINGS

CXR identified 6 CVL misplacements (8,4%, CI 95% 3,2%-18%). Four of these were intravascular and 2 in the right atrium. CEUS identified only 3 misplacements, of which 1 was intravascular and 2 intracardiac. Using CXR as a reference standard, and considering intravascular and intracardiac malpositioning altogether, the sensitivity, specificity, and positive and negative likelihood ratio of CEUS were 33% (95% CI, 0%-71%), 98% (95% CI, 95%-100%), 21%, 7%, 0%, and 68%, respectively. The negative and positive predictive values were 94% (95% CI, 89%-100%) and 67% (95% CI, 13%-100%).

PRINCIPAL CONCLUSIONS

CEUS can't substitute CXR, or become a triage test in selected patients, in evaluating the correct tip position after CVL placement.

摘要

目的

我们旨在分析对比增强超声（CEUS）与胸部 X 射线（CXR）在检测中心静脉导管（CVL）正确位置中的诊断准确性。我们的假设是验证 CEUS 是否可以替代 CXR 作为 CVL 正确放置的参考标准，或者作为一种分诊测试，仅对选定的患者进行 CXR 检查。

基本程序

对 71 例非连续患者进行 CEUS 检查，以验证中心静脉导管的正确位置。计算 CEUS 与 CXR 相比的敏感性、特异性、阳性和阴性预测值以及似然比，并计算其各自的 95%置信区间（CI）。

主要发现

CXR 发现 6 例 CVL 错位（8.4%，95%CI 95% 3.2%-18%）。其中 4 例为血管内，2 例在右心房。CEUS 仅发现 3 例错位，其中 1 例为血管内，2 例为心内。以 CXR 为参考标准，将血管内和心内错位一并考虑，CEUS 的敏感性、特异性、阳性和阴性似然比分别为 33%（95%CI，0%-71%）、98%（95%CI，95%-100%）、21%、7%、0%和 68%。阴性和阳性预测值分别为 94%（95%CI，89%-100%）和 67%（95%CI，13%-100%）。