不同定位方法對早產(chǎn)兒臍靜脈置管后異位的影響

應(yīng)勤來　劉玨　張旭　侯秋英　朱雯

[關(guān)鍵詞] 早產(chǎn)兒;臍靜脈置管;定位方法;超聲

[中圖分類號] R459.7? ? ? ? ? [文獻標(biāo)識碼] B? ? ? ? ? [文章編號] 1673-9701（2021）22-0062-04

Investigation on the effects of different positioning methods on ectopy after umbilical vein catheterization in premature infants

YING Qinlai? ?LIU Jue? ?ZHANG Xu? ?HOU Qiuying? ?ZHU Wen

Department of Neonatal，the Second Hospital of Jiaxing City in Zhejiang Province， Jiaxing? ?314000， China

[Abstract] Objective To explore the effect of different positioning methods on ectopy after umbilical vein catheterization in premature infants. Methods From January 2018 to December 2019，a total of 66 cases of premature infants in the neonatal intensive care unit （NICU） of our hospital were selected and divided into two groups （X-ray radiography positioning group of 33 cases and ultrasound positioning group of 33 cases）. The number of cases of successful catheterization was observed in both groups; the ectopic conditions were examined by ultrasound 24 h， 48 h， and 4 days after the catheterization. Results The success rates of X-ray radiography positioning and ultrasound positioning group after umbilical vein catheterization were 87.9% and 90.9% with no statistical significance（P=0.689）; the position of the catheter was screened by ultrasound 24 hours after the catheterization. The ectopic rate of X-ray radiography positioning were 34.5% and 10.0%（P=0.023， with statistical significance）; the ectopic composition ratio was compared between 48 h and 4 days，and the P value was not statistically significant（P>0.05）. Conclusion Ultrasound positioning after umbilical vein catheterization is more accurate than X-ray radiography in positioning the catheter tip. The two positioning methods after catheter placement should be repeatedly screened with ultrasound technology on a regular basis. Regular inspections with ultrasound technology can ensure that the umbilical vein catheter is kept in place and prevent complications.

[Key words] Premature infants; Umbilical vein catheterization; Positioning methods; Ultrasound

早產(chǎn)兒是指胎齡<37周的新生兒，早產(chǎn)兒由于發(fā)育未成熟，尤其是出生后1周內(nèi)往往因為喂養(yǎng)困難而需要靜脈營養(yǎng)，因此，在臨床實踐中，選擇合理的方式建立靜脈通道十分重要。早產(chǎn)兒外周靜脈腔徑細，管壁薄，置管及護理的難度大。而出生后臍部結(jié)扎，可以暴露臍部的血管（1條臍靜脈，2條臍動脈），臍靜脈（Umbilical vein，UV）的管徑相對外周靜脈粗，上行可至下腔靜脈，故可以作為早產(chǎn)兒出生后早期營養(yǎng)的優(yōu)選靜脈。臍靜脈置管（Umbilical venous catheter，UVC）營養(yǎng)補液在早產(chǎn)兒特別是極低出生體重兒（VLBW）和超低出生體重兒（ELBW）中的應(yīng)用也越來越廣泛。置管后導(dǎo)管尖端的理想解剖位置是右心房外側(cè)下腔靜脈中或胸腔內(nèi)下腔靜脈中[1-2]，尖端位置與置管后留置導(dǎo)管時間長短、并發(fā)癥的發(fā)生密切相關(guān)，導(dǎo)管的異位與并發(fā)癥的發(fā)生呈正相關(guān)[3]。導(dǎo)管異位指偏離理想解剖位置，本研究定義導(dǎo)管異位（圖1）：①過低：導(dǎo)管尖端處于膈肌平面以下或未入下腔靜脈內(nèi);②過高：導(dǎo)管尖端處于上腔靜脈中或進入心臟（右心房、右心室、左心房）。目前臨床上可靠的定位方法是置管固定后行X線攝片定位和超聲定位。故本研究選取66例早產(chǎn)嬰兒，盲插置管后分別選用不同定位方法，并在使用過程中定期用超聲技術(shù)反復(fù)檢查，來探討不同定位方法對早產(chǎn)兒臍靜脈置管后異位的影響，現(xiàn)報道如下。