超声定位的中心静脉导管尖端位置和流量的关系

doi:10.3969/j.issn.1006-6233.2020.01.034

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摘要 目的:分析经颈内静脉中心静脉导管(central venous catheter,CVC)置入术后患者导管尖端位置和流量的关系。方法:选取经颈内静脉CVC术后维持性血液透析的患者225例。根据超声观察导管尖端位置进行分组,1组为导管尖端位于上腔静脉(superior vena cava,SVC)内,2组为导管尖端位于右心房中上部水平(包括上腔静脉入右房口水平),3组为心腔内其它位置。记录术后24h内首次使用CVC进行透析时1h内的导管动静脉端实际泵流量(mL/min),比较组间流量。结果:1组血流量中位数为240mL/min,2组血流量中位数为250mL/min,3组血流量中位数为230mL/min,3组导管尖端位置不同的患者导管流量比较差异有统计学意义(P<0.05),进一步进行组间两两比较,其中p(1组/2组)=0.001、p(2组/3组)=0.000,差异有统计学意义。结论:经颈内静脉的中心静脉导管透析流量与导管尖端位置有关,在右房中上部水平血流量最佳,超声监测导管尖端位置具有一定价值。

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关键词 ：超声, 中心静脉导管, 尖端位置, 流量

Abstract：Objective: To analyze the relationship between the position of catheter tip and flow rate in patients undergoing transjugular central venous catheter placement. Methods: 225 patients with maintenance hemodialysis were treated with transjugular central venous catheterization. According to the position of the tip of the catheter, the Group 1 is located in the superior vena cava, the Group 2 is located in the upper middle level of the right atrium (including the upper vena cava into the right atrium level), and the Group 3 is in the other locations within the heart chamber. The actual pump flow (ml/min) at the arteriovenous end of the catheter within 1 hour after the first use of CVC for dialysis within 24 hours after surgery was recorded, and the flow between the groups was compared. Results: The median blood flow of the Group 1 was 240 ml/min. The median blood flow of the Group 2 was 250 ml/min, and the median blood flow of the Group 3 was 230 ml/min, there was a statistically significant difference (P<0.05) in catheter flow between the three groups with different catheter tip positions. Further comparison between the groups was made, p (Group 1/Group 2)=0.001、p (Group 2/Group 3) = 0.000, difference was statistically significant. Conclusion: The dialysate flow of the central venous catheter through the internal jugular vein is related to the tip position of the catheter. The best level of blood flow is in the upper middle part of the right atrium. Ultrasound monitoring the tip position of the catheter has a certain value.

Key words： Ultrasound Central venous catheter Tip position Flow

通讯作者: 刘会玲

引用本文:

杜悦, 刘会玲, 丁华杰, 李伟宏, 陈瑶. 超声定位的中心静脉导管尖端位置和流量的关系[J]. 河北医学, 2020, 26(1): 143-145.
DU Yue, LIU Huiling, DING Huajie, et al. Relationship between the Position of the Tip of the Central Venous Catheter Positioned by Ultrasound and Flow Rate. HeBei Med, 2020, 26(1): 143-145.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2020.01.034 或 http://www.hbyxzzs.cn/CN/Y2020/V26/I1/143