新生儿外周静脉穿刺中心静脉置管中床边超声检查与床边胸部X线摄影的比较：一项自身前后对照研究。
Comparison of bedside ultrasonography and bedside chest radiography in neonatal peripherally inserted central catheters: A before and after self-control study.
作者信息
Liu Xuexiu, Tao Xiaojun, Xu Ye, Zhang Xianhong, Chen Yanhan, Wu Liping
机构信息
Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China.
Radiology Department, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
出版信息
Front Pediatr. 2022 Oct 18;10:976826. doi: 10.3389/fped.2022.976826. eCollection 2022.
OBJECTIVE
This study aimed to compare the applications of bedside ultrasonography (US) and bedside chest radiography (CR) in positioning peripherally inserted central venous catheter (PICC) at Neonatal Intensive Care Units (NICUs).
METHODS
The study is a prospective before and after self-control clinical trial. A consecutive series of 181 neonate patients were finally enrolled for PICC placement. CR, followed by US, was used to evaluate and readjust the sites of catheter tips. The imaging capability for PICC key structures, fluctuation of the measured data, measurement of tip-to-atrium distance, operation time, infants' body temperature changes, and direct expenses of the two imaging modalities were obtained and compared.
RESULTS
(1) Comparison in viewing PICC key structures: the display rate of catheter tip, SVC-and-right-atrium junction, IVC-and-right-atrium junction and tip-to-atrium distance is 99.47%, 100%, 100% and 99.47% for US and 100%, 98.42%, 97.37% and 95.79% for CR, respectively. (2) Fluctuation of the measured data by US and CR: the tip-to-atrium distance measured by US is 0.631 (0.435-0.820) cm, and that measured by CR is 0.593 (0.210-0.825) cm. US showed a narrower range of datum variance. (3) Consistency between US and CR: for consistency analysis, the Kappa coefficient () was 0.843 ( < 0.05), showing their favorable consistency. (4) Comparison of operation time and infants' body temperature drop: for a CR exam, the time period taken was significantly longer than that of US (59.7 ± 26.33 vs. 79.6 ± 28.06, < 0.001); and CR operations caused a significant babies' body temperature drop compared to US (0.14 ± 0.11 vs. 0.34 ± 0.19, < 0.001). (5) Comparison of the direct expenses: the total cost for CR positioning was significantly higher than that for US (¥153.99 vs. ¥143, = 0.026).
CONCLUSION
US exhibited superior traits to CR in the positioning of PICC tip. It could be promising for routine use in NICU.
目的
本研究旨在比较床旁超声（US）和床旁胸部X线摄影（CR）在新生儿重症监护病房（NICU）中对外周静脉置入中心静脉导管（PICC）的定位应用。
方法
本研究为一项前瞻性自身对照临床试验。最终纳入181例连续的新生儿患者进行PICC置管。先采用CR，然后采用US来评估和调整导管尖端位置。获取并比较两种成像方式对PICC关键结构的成像能力、测量数据的波动、尖端至心房距离的测量、操作时间、婴儿体温变化以及直接费用。
结果
（1）PICC关键结构观察比较：US对导管尖端、上腔静脉与右心房交界处、下腔静脉与右心房交界处以及尖端至心房距离的显示率分别为99.47%、100%、100%和99.47%，CR分别为100%、98.42%、97.37%和95.79%。（2）US和CR测量数据的波动：US测量的尖端至心房距离为0.631（0.435 - 0.820）cm，CR测量的为0.593（0.210 - 0.825）cm。US显示的数据方差范围更窄。（3）US和CR之间的一致性：一致性分析中，Kappa系数（）为0.843（<0.05），显示出良好的一致性。（4）操作时间和婴儿体温下降的比较：CR检查所用时间显著长于US（59.7±26.33对79.6±28.06，<0.001）；与US相比，CR操作导致婴儿体温显著下降（0.14±0.11对0.34±0.19，<0.001）。（5）直接费用比较：CR定位的总费用显著高于US（153.99元对143元，=0.026）。
结论
在PICC尖端定位方面，US表现出优于CR的特性。它有望在NICU中常规使用。
Zotero 插件