【摘要】：目的探討極低出生體重兒PICC尖端位置與體重增長(zhǎng)的相關(guān)性。方法回顧分析某三級(jí)甲等醫(yī)院新生兒重癥監(jiān)護(hù)室中的極低出生體重兒留置PICC期間所拍攝的胸片,記錄胸片上的導(dǎo)管尖端位置,采用椎體定位計(jì)算導(dǎo)管尖端位置改變。計(jì)算拍攝胸片當(dāng)日和首次定位時(shí)相比的體重增長(zhǎng)率。采用Spearman等級(jí)相關(guān)法分析胸片上導(dǎo)管尖端移位和體重增長(zhǎng)之間的關(guān)系。結(jié)果共有57例極低出生體重兒和246張胸片納入研究。首次拍攝胸片當(dāng)日體重為0.60~1.46(1.06±0.25)kg;日齡中位數(shù)和四分位間距為5(3,7)d。末次胸片時(shí)間為置管后(24.0±9.1)d;體重增長(zhǎng)率為11.8%~114.8%,中位數(shù)和四分位間距為41.5%(27.1%,65.3%);全部患兒的PICC尖端位置出現(xiàn)改變,中位數(shù)和四分位間距為3(1.8,3.5)個(gè)椎體,其中75%出現(xiàn)2個(gè)椎體以上的移位,50%有3個(gè)椎體的移位。導(dǎo)管尖端偏移的幅度和體重增長(zhǎng)率相關(guān)。在體重達(dá)到40%、70%、100%的增長(zhǎng)率時(shí),相對(duì)應(yīng)的PICC尖端出現(xiàn)近似2個(gè)、3個(gè)和4個(gè)椎體的移位。PICC尖端位置改變和體重增長(zhǎng)顯著相關(guān)(r=-0.7,P0.01);但不同體表穿刺部位二者的相關(guān)性有差異。結(jié)論極低出生體重兒的PICC尖端位置受體重增長(zhǎng)影響。結(jié)合PICC首次定位,體重增長(zhǎng)40%、70%是導(dǎo)管位置追蹤的關(guān)鍵時(shí)機(jī)。體重增長(zhǎng)100%應(yīng)拔除或更換導(dǎo)管。通過(guò)易受骨骼生長(zhǎng)和肢體動(dòng)作影響部位穿刺的PICC,需提高導(dǎo)管定位的頻次。
[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 鹵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 鹵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 鹵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.
【作者單位】： 浙江大學(xué)醫(yī)學(xué)院附屬兒童醫(yī)院新生兒重癥監(jiān)護(hù)室;
【基金】：浙江省教育廳一般科研項(xiàng)目(Y201636377)
【分類號(hào)】：R473.72

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