极低出生体重儿PICC导管尖端位置与体重增长相关性分析

发布时间：2018-05-01 18:58

本文选题：婴儿 + 出生时低体重　；参考：《浙江大学》2017年硕士论文

【摘要】：目的:探讨极低出生体重儿PICC尖端位置与体重增长的相关性。了解导致导管发生移位的相关因素,明确导管定位的时机。方法:回顾分析某三级甲等医院新生儿重症监护室中的极低出生体重儿留置PICC期间所拍摄的胸片。记录胸片上的导管位置,采用椎体定位计算导管尖端位置改变。计算拍片当日和首次定位时的体重增长率。采用Spearman等级相关法分析胸片上导管尖端移位和体重增长之间的关系。结果:共有57例极低出生体重儿246张胸片符合纳入研究。首次拍摄胸片当日体重为0.6-1.46(1.06±0.25)kg;日龄为1-12(7.1±6.1)d。末次胸片时间为置管后(24±9.1)d;体重增长率为11.8%～114.8%,平均45.8%±27.3%;全部患儿的PICC导管尖端位置出现改变,其中75%出现2个椎体以上的改变,50%有3个椎体的移位,平均移位(2.5±1.5)个椎体。导管尖端偏移的幅度和体重增长率相关。在体重达到40%、70%、100%的增长率时,相对应的PICC导管尖端出现近似2个、3个和4个椎体的移位。PICC尖端位置改变和体重增长显著相关(r=-0.7,P0.01);但不同体表穿刺部位二者的相关性有差异。结论:极低出生体重儿的PICC尖端位置受体重增长影响显著。结合PICC首次定位,体重增长40%、70%是导管位置追踪的关键时机。体重增长100%应拔除或更换导管。易受骨骼生长和肢体动作影响部位穿刺的PICC,需提高导管定位的频次。
[Abstract]:Objective: to investigate the relationship between PICC tip position and weight gain in very low birth weight infants. Understand the relevant factors leading to catheter displacement and determine the timing of catheter location. Methods: the chest radiographs of very low birth weight infants during PICC indwelling in the neonatal intensive care unit of a Grade 3A hospital were analyzed retrospectively. The location of catheter on chest radiography was recorded and the change of tip position of catheter was calculated by vertebra position. The weight growth rate on the day of the film and the first positioning was calculated. The relationship between tip shift and weight gain on chest radiographs was analyzed by Spearman grade correlation method. Results: a total of 57 very low birth weight infants with 246 chest radiographs were enrolled in the study. The body weight of the first chest radiographs was 0.6-1.46g 1.06 卤0.25g / kg, and that of the day was 1-127.1 卤6.1d. The time of the last chest radiography was 24 卤9.1 days after catheterization, the growth rate of body weight was 114.8% (mean 45.8% 卤27.3%), the tip position of PICC catheter was changed in all the children, 75% of them had 2 vertebrae above 2 vertebrae and 50% had 3 vertebrae displacement, with an average displacement of 2.5 卤1.5). The extent to which the tip of the catheter is shifted is related to the growth rate of body weight. At the growth rate of 100% in weight, there were approximately 2 tips of the corresponding PICC catheter, 3 and 4 vertebrae displacement. The change of tip position and weight gain were significantly correlated with r-0.7 and P0.01, but the correlation between the two sites was different. Conclusion: the PICC tip position of very low birth weight infants is significantly affected by weight gain. Combined with PICC's initial positioning, 40% weight gain is a critical time to track the location of the catheter. The catheter should be removed or replaced by 100% weight gain. PICC, which is easily affected by bone growth and limb movement, needs to increase the frequency of catheter location.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.72

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