PICC术后胸片上导管头端定位标志的选择及临床应用

摘要

目的：研究右侧第6、7后肋间隙、右侧第6后肋、右侧第7后肋与上腔静脉入右心房口（ CAJ）的位置关系，分析其作为PICC术后导管头端定位标志临床应用价值。方法胸部16排CT平扫的体检者213例，以CT定位相作为模拟X线平片，通过CT图像测量右侧第6、7后肋间隙、右侧第6后肋、右侧第7后肋至CAJ的距离，采用统计学方法分析各影像解剖结构与CAJ的位置关系及其作为PICC定位标志的有效性和安全性。结果右侧第6、7后肋间隙、右侧第6后肋、右侧第7后肋至CAJ的距离分别为（19．446±14．4981）mm、（28．232±16．7217）mm、（13．741±11．1473）mm，各组间对比存在统计学差异（χ2＝93．793， P ＝0．000）；实测距离分析，位于0～20mm理想位置和＜0mm危险位置者所占比例分别为45．5％、14．6％，31．9％、4．2％，43．2％、39．4％，各组资料间存在统计学差异（χ2＝11．040， P ＝0．000）。结论右侧第7后肋至CAJ的距离最近且波动性最小，但作为PICC置管定位标志安全性较低，综合比较右侧第6、7后肋间隙作为PICC术后胸片上导管头端定位标志为宜。%Objective To find the best positioning reference point in the chest photography after PICC replacement by measur-ing CT images.Methods From January 2015 to June 2015, the physical examination data of 213 cases with chest CT examina-tion were collected to measure and analyze the lengths from the intercostal space between the 6 th and 7 th posterior fib, the 6 th right posterior fib, the 7 th right posterior fib to Cavoatrial junction( CAJ) .Results The lengths from the intercostal space be-tween the 6 th and 7 th posterior fib, the 6 th right posterior fib, the 7 th right posterior fib to CAJ were (19.446 ±14.4981) mm, (28.232 ±16.7217) mm, (13.741 ±11.1473) mm, the difference had statistically significant (χ2 =93.793, P =0.000).In the four groups, the percent of cases, whose lengths were 0~20 mm, were 45.5%, 31.9%, 43.2%, and the per-cent of cases, whose lengths were <0 mm, were 14.6%, 4.2%, 39.4%, the difference had statistically significant (χ2 =11.040, P =0.000).Conclusion The intercostal space between the 6 th and 7 th posterior fib is the better choice than the 6 th right posterior fib and the 7 th right posterior fib as the positioning reference point after PICC replacement.