用于急性创伤复苏的中心静脉置管：使用常规急诊计算机断层扫描进行尖端位置分析

Central venous catheterization for acute trauma resuscitation: Tip position analysis using routine emergency computed tomography.

作者信息

Struck Manuel F, Ewens Sebastian, Schummer Wolfram, Busch Thilo, Bernhard Michael, Fakler Johannes K M, Stumpp Patrick, Stehr Sebastian N, Josten Christoph, Wrigge Hermann

机构信息

1 Department of Anaesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany.

2 Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany.

出版信息

J Vasc Access. 2018 Sep;19(5):461-466. doi: 10.1177/1129729818758998. Epub 2018 Mar 12.

DOI:10.1177/1129729818758998

PMID:29529967

Abstract

PURPOSE

Central venous catheter insertion for acute trauma resuscitation may be associated with mechanical complications, but studies on the exact central venous catheter tip positions are not available. The goal of the study was to analyze central venous catheter tip positions using routine emergency computed tomography.

METHODS

Consecutive acute multiple trauma patients requiring large-bore thoracocervical central venous catheters in the resuscitation room of a university hospital were enrolled retrospectively from 2010 to 2015. Patients who received a routine emergency chest computed tomography were analyzed regarding central venous catheter tip position. The central venous catheter tip position was defined as correct if the catheter tip was placed less than 1 cm inside the right atrium relative to the cavoatrial junction, and the simultaneous angle of the central venous catheter tip compared with the lateral border of the superior vena cava was below 40°.

RESULTS

During the 6-year study period, 97 patients were analyzed for the central venous catheter tip position in computed tomography. Malpositions were observed in 29 patients (29.9%). Patients with malpositioned central venous catheters presented with a higher rate of shock (systolic blood pressure <90 mmHg) at admission (58.6% vs 33.8%, p = 0.023) and a higher mean injury severity score (38.5 ± 15.7 vs 31.6 ± 11.8, p = 0.041) compared with patients with correctly positioned central venous catheter tips. Logistic regression revealed injury severity score as a significant predictor for central venous catheter malposition (odds ratio = 1.039, 95% confidence interval = 1.005-1.074, p = 0.024).

CONCLUSION

Multiple trauma patients who underwent emergency central venous catheter placement by experienced anesthetists presented with considerable tip malposition in computed tomography, which was significantly associated with a higher injury severity.

摘要

目的

用于急性创伤复苏的中心静脉导管插入术可能会伴有机械并发症，但关于中心静脉导管确切尖端位置的研究尚不可得。本研究的目的是使用常规急诊计算机断层扫描分析中心静脉导管的尖端位置。

方法

回顾性纳入2010年至2015年在一所大学医院复苏室需要大口径胸颈段中心静脉导管的连续急性多发伤患者。对接受常规急诊胸部计算机断层扫描的患者的中心静脉导管尖端位置进行分析。如果导管尖端相对于腔房交界处位于右心房内小于1厘米处，且中心静脉导管尖端与上腔静脉外侧边界的同时角度低于40°，则将中心静脉导管尖端位置定义为正确。

结果

在6年的研究期间，对97例患者的计算机断层扫描中的中心静脉导管尖端位置进行了分析。29例患者（29.9%）出现位置不当。与中心静脉导管尖端位置正确的患者相比，中心静脉导管位置不当的患者入院时休克发生率更高（收缩压<90 mmHg）（58.6%对33.8%，p = 0.023），平均损伤严重程度评分更高（38.5±15.7对31.6±11.8，p = 0.041）。逻辑回归显示损伤严重程度评分是中心静脉导管位置不当的重要预测因素（优势比=1.039，95%置信区间=1.005 - 1.074，p = 0.024）。