Mokrohisky S T, Levine R L, Blumhagen J D, Wesenberg R L, Simmons M A
N Engl J Med. 1978 Sep 14;299(11):561-4. doi: 10.1056/NEJM197809142991101.
We performed a randomized prospective study of the effect of placement position of umbilical-artery catheters on complication rates in high-risk newborn infants. A higher complication rate (31 of 40 vs. 13 of 33) (P less than 0.005) occurred in the group with the catheter tip at the third to fourth lumbar segment, as compared to those with the tip at the seventh to eighth thoracic segment, owing to more episodes of blanching and cyanosis of the extremities. There was no difference between groups in the rate of complications requiring catheter removal. Aortography revealed thrombosis in 21 of 23 patients studied, but there was no clinical evidence of impaired circulation. In retrospect, we found that, independently of catheter position, administration of antibiotics through the catheter was associated with an increased rate of complications (63 vs. 20 per cent). Umbilical-artery catheterization entails potential risks regardless of the position of the catheter; placement of the catheter with its tip at the seventh to eighth thoracic segment may be associated with fewer complications than at lower positions.
我们针对脐动脉导管放置位置对高危新生儿并发症发生率的影响进行了一项随机前瞻性研究。与导管尖端位于胸段第七至八节的组相比，导管尖端位于腰段第三至四节的组并发症发生率更高（40例中有31例，33例中有13例）（P小于0.005），原因是肢体出现更多的皮肤变白和发绀情况。两组在需要拔除导管的并发症发生率方面无差异。血管造影显示，在研究的23例患者中有21例出现血栓形成，但无循环受损的临床证据。回顾性分析发现，与导管位置无关，通过导管使用抗生素与并发症发生率增加相关（63%对20%）。无论导管位置如何，脐动脉插管都存在潜在风险；导管尖端置于胸段第七至八节的位置可能比更低位置的并发症更少。
