体尺和体重测量在新生儿脐静脉置管深度的随机对照研究
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摘要
目的对比体尺和体重测量方法在脐静脉置管深度评估的临床应用效果,以探讨体尺测量方法在评估脐静脉置管深度的可行性。方法选取住院并需行脐静脉置管的低体重新生儿共110例,根据数字顺序排列分为体尺组和体重组,每组55例,在脐静脉置管前分别采用体尺法和体重法评估置管深度,对比两组新生儿脐静脉置管的预计置管深度、初次置管的成功率、初次准确置管率、初次置管导管尖端位置高于或低于准确范围的例数以及置管期间的并发症。结果体尺组新生儿其预计置管深度为(7. 19±0. 32) cm,体重组为(7. 25±0. 41) cm,两组对比差异无统计学意义(t=0. 856,P=0. 394),其中体尺组初次准确置管率为90. 6%,而体重组为75. 0%,体尺组显著高于体重组,差异有统计学意义(2=4. 447,P=0. 034),而两组新生儿导管尖端过高和导管尖端过低的比例对比差异均无统计学意义(P> 0. 05),两组新生儿出现败血症、置管后出血、坏死性肠炎、肝静脉栓塞和总并发症的发生率对比差异均无统计学意义(P> 0. 05)。结论体尺测量法能更准确地评估新生儿脐静脉置管深度,其准确性优于体重法,临床应用安全性良好,是可行的脐静脉置管深度评估方法。
引文
[1]杨祖铭,王三南,马月兰,等.脐静脉联合外周中心静脉置管在极低出生体重儿中的应用[J].中国当代儿科杂志,2013,15(5):353-355.
[2] Pulickal AS,Charlagorla PK,Tume SC,et al. Superiority of targeted neonatal echocardiographyfor umbilical venous catheter tip localization:accuracy of aclinician performance model[J]. J Perinatol,2013,33(12):950-953.
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[6] Michel F,Brevaut-Malaty V,Pasquali R,et al. Comparison of ultrasound and X-ray in determining the position of umbilical venous catheters[J]. Resuscitation,2012,83(6):705-709.
[7] Dunn PM. Localization of the umbilical catheter by post-mortem measurement[J]. Arch Dis Child,1966,41(215):69-75.
[8] Kieran EA,Laffan EE, O'Donnell CP. Estimating umbilical catheter insertion depth in newborns using weight or body measurement:a randomised trial[J]. Arch Dis Child Fetal Neonatal Ed,2016,101(1):F10-F15.
[9]邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M]. 4版.北京:人民卫生出版社,2012:923.
[10] Kieran EA,O'Donnell CP. Accuracy of length measurements on neonatal umbilical catheters[J]. Arch Dis Child Fetal Neonatal Ed,2014,99(6):F520-F521.
[11]林创廷,黄翔,王巧洪,等.超声定位与标准X线在新生儿脐静脉置管后异位评估的效果对比[J].广东医学,2018,39(14):2196-2199.
[12]申春花,李丽菊,蒋永江,等.新生儿脐静脉置管实时超声引导法的探讨[J].临床超声医学杂志,2017,19(5):335-337.
[13]茹喜芳,冯琪,王颖,等.早产儿脐静脉导管相关性肝损伤的临床分析[J].中国新生儿科杂志,2017,32(1):11-15.
[14]梁淑文,崔其亮,谭小华,等.新生儿脐静脉置管术后腹胀的危险因素分析[J].中国新生儿科杂志,2012,27(4):247-249.
[15]冯琳,高晓燕,潘新年,等.新生儿脐静脉置管留置时间与导管位置及并发症关系分析[J].医学信息,2016,29(4):46-47.
[2] Pulickal AS,Charlagorla PK,Tume SC,et al. Superiority of targeted neonatal echocardiographyfor umbilical venous catheter tip localization:accuracy of aclinician performance model[J]. J Perinatol,2013,33(12):950-953.
[3]田淑萍,李刚.脐静脉置管术在早产儿中的应用及其并发症的防治[J].中国妇幼保健,2012,27(21):3371-3372.
[4] Oestreich AE. Umbilical vein catheterization-appropriate and inappropriate placement[J]. Pediatr Radiol, 2010, 40(12):1941-1949.
[5] Hoellering AB,Koorts PJ,Cartwright DW,et al. Determination of umbilical venous catheter tip position with radiograph[J]. Pediatr Crit Care Med,2014,15(1):56-61.
[6] Michel F,Brevaut-Malaty V,Pasquali R,et al. Comparison of ultrasound and X-ray in determining the position of umbilical venous catheters[J]. Resuscitation,2012,83(6):705-709.
[7] Dunn PM. Localization of the umbilical catheter by post-mortem measurement[J]. Arch Dis Child,1966,41(215):69-75.
[8] Kieran EA,Laffan EE, O'Donnell CP. Estimating umbilical catheter insertion depth in newborns using weight or body measurement:a randomised trial[J]. Arch Dis Child Fetal Neonatal Ed,2016,101(1):F10-F15.
[9]邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M]. 4版.北京:人民卫生出版社,2012:923.
[10] Kieran EA,O'Donnell CP. Accuracy of length measurements on neonatal umbilical catheters[J]. Arch Dis Child Fetal Neonatal Ed,2014,99(6):F520-F521.
[11]林创廷,黄翔,王巧洪,等.超声定位与标准X线在新生儿脐静脉置管后异位评估的效果对比[J].广东医学,2018,39(14):2196-2199.
[12]申春花,李丽菊,蒋永江,等.新生儿脐静脉置管实时超声引导法的探讨[J].临床超声医学杂志,2017,19(5):335-337.
[13]茹喜芳,冯琪,王颖,等.早产儿脐静脉导管相关性肝损伤的临床分析[J].中国新生儿科杂志,2017,32(1):11-15.
[14]梁淑文,崔其亮,谭小华,等.新生儿脐静脉置管术后腹胀的危险因素分析[J].中国新生儿科杂志,2012,27(4):247-249.
[15]冯琳,高晓燕,潘新年,等.新生儿脐静脉置管留置时间与导管位置及并发症关系分析[J].医学信息,2016,29(4):46-47.