极低出生体重儿PICC尖端位置与体重增长的相关性分析

发布时间：2018-08-02 16:24

【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。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,记录胸片上的导管尖端位置,采用椎体定位计算导管尖端位置改变。计算拍摄胸片当日和首次定位时相比的体重增长率。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例极低出生体重儿和246张胸片纳入研究。首次拍摄胸片当日体重为0.60~1.46(1.06±0.25)kg;日龄中位数和四分位间距为5(3,7)d。末次胸片时间为置管后(24.0±9.1)d;体重增长率为11.8%~114.8%,中位数和四分位间距为41.5%(27.1%,65.3%);全部患儿的PICC尖端位置出现改变,中位数和四分位间距为3(1.8,3.5)个椎体,其中75%出现2个椎体以上的移位,50%有3个椎体的移位。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。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。通过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. 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 the tip of the catheter was recorded and the changes of the tip position of the catheter were calculated by vertebrae location. The weight growth rate was calculated on the day of chest film and at the time of first positioning. 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 and 246 chest radiographs were included in the study. The body weight was 0.60 ~ 1.46 (1.06 卤0.25) kg on the day of the first chest radiography, and the median age and quartile spacing were 5 (3 ~ 7) d. The time of the last chest radiography was (24.0 卤9.1) days after catheterization, the growth rate of body weight was 114.8 and the median and quartile spacing was 41.5% (27.1 卤65.3%), the PICC tip position of all the children was changed, the median and quartile distances were 3 (1.83.5) vertebrae. Of these, 75% had more than 2 vertebrae and 50% had 3 vertebrae. The extent to which the tip of the catheter is shifted is related to the growth rate of body weight. When the body weight reached 100%, the corresponding PICC tips were approximately 2, 3 and 4 vertebrae shifted. The tip position change was significantly correlated with weight gain (r = -0.7, P 0.01), but the correlation between the two sites was different. Conclusion the PICC tip position of very low birth weight infants is 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. It is necessary to increase the frequency of catheter location through PICC, which is easily affected by bone growth and limb movement.
【作者单位】：浙江大学医学院附属儿童医院新生儿重症监护室;
【基金】：浙江省教育厅一般科研项目(Y201636377)
【分类号】：R473.72

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