经外周静脉穿刺中心静脉置管术后胸片上导管头端定位点的选择应用

摘要

Objective:To find the best positioning reference point in the chest photography after PICC replacement by measur-ing CT images. Methods:The physical examination data of 213 cases with chest CT examination were collected to measure and analyze the length from the intercostal space between the 6th and 7th posterior fib,the 6th right posterior fib,the 7th right pos-terior fib to cavoatrial junction (CAJ). Results:The length from the intercostal space between the 6th and 7th posterior fib,the 6th right posterior fib,the 7th right posterior fib to CAJ was (19.446±14.4981)mm、(28.232±16.7217)mm、(13.741±11.1473) mm,the difference was statistically significant (χ2=93.793,P=0.000). In the four groups,the percent of cases whose lengths were 0~20 mm was 45.5%,31.9%,43.2%,and the percent of cases whose lengths were <0 mm were 14.6%,4.2%,39.4%,the differ-ence was statistically significant(χ2=11.040,P=0.000). Conclusion:The intercostal space between the 6th and 7th posterior fib is the better choice than the 6th right posterior fib and the 7th right posterior fib as the positioning reference point after PICC replacement.%目的：分析右侧第六七后肋间隙、右侧第六后肋、右侧第七后肋与上腔静脉入右心房口（CAJ）的位置关系，寻找经外周置入中心静脉导管（PICC）术后胸片上导管头端的最佳定位点。方法：选择我院行胸部16排CT平扫的体检者213例，以CT定位相模拟X线平片，通过对应CT图像测量右侧第六七后肋间隙、右侧第六后肋、右侧第七后肋至CAJ的距离，并行统计学分析。结果：右侧第六七后肋间隙、右侧第六后肋、右侧第七后肋至CAJ的距离差异有统计学意义（χ2=93.793，P=0.000）。 PICC导管头端置于右侧第六七后肋间隙、右侧第六后肋、右侧第七后肋时，其与CAJ距离0～20 mm及<0 mm者差异有统计学意义（χ2=11.040，P=0.000）。结论：右侧第七后肋是最接近CAJ投影点位置，但作为PICC置管定位标志安全性较低；综合比较，右侧第六七后肋间隙作为PICC术后胸片上导管头端定位标志为宜。