| 胡燕标,吴飞飞,江怡,王燕辉,谢平坤,夏诗勇,彭稳稳,陈旭东,汤升,张景峰.胸椎正位片用于经外周置入中心静脉导管术后定位导管尖端[J].中国医学影像技术,2021,37(7):1016~1019 |
| 胸椎正位片用于经外周置入中心静脉导管术后定位导管尖端 |
| Frontal thoracic spine X-ray film for tip positioning after implantation of peripherally inserted central catheter |
| 投稿时间：2020-07-08 修订日期：2021-05-12 |
| DOI：10.13929/j.issn.1003-3289.2021.07.012 |
| 中文关键词: 导管插入术,中心静脉 定位 体层摄影术,X线 胸椎 |
| 英文关键词:catheterization, central venous position tomography, X-ray thoracic vertebrae |
| 基金项目:浙江省医药卫生科技计划（2019ZH037）。 |
| 作者 | 单位 | E-mail | | 胡燕标 | 宁波市北仑区人民医院放射科, 浙江 宁波 315800 | feihu9880@163.com | | 吴飞飞 | 宁波市北仑区人民医院放射科, 浙江 宁波 315800 | | | 江怡 | 宁波市北仑区人民医院放射科, 浙江 宁波 315800 | | | 王燕辉 | 宁波市北仑区人民医院放射科, 浙江 宁波 315800 | | | 谢平坤 | 宁波市北仑区人民医院放射科, 浙江 宁波 315800 | | | 夏诗勇 | 宁波市北仑区人民医院放射科, 浙江 宁波 315800 | | | 彭稳稳 | 宁波市北仑区人民医院放射科, 浙江 宁波 315800 | | | 陈旭东 | 宁波市北仑区人民医院放射科, 浙江 宁波 315800 | | | 汤升 | 宁波市北仑区人民医院放射科, 浙江 宁波 315800 | | | 张景峰 | 中国科学院大学宁波华美医院放射科, 浙江 宁波 315010 | |
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| 中文摘要: |
| 目的 评估胸椎X线正位片用于经外周置入中心静脉导管（PICC）术后定位导管尖端的价值。方法 回顾性分析114例接受PICC患者，术后接受1次以上胸部X线正位摄影、胸椎X线正位摄影及胸部CT，其中胸椎正位片183例次（A组），胸部正位片334例次（B组）。对胸部CT纵隔窗图像进行重建联动轴位、冠状位、矢状位多平面重组，以多切面观察确定上腔静脉与右心房连接处（CAJ）位置及对应的轴位CT层面，确定CAJ位置，并于定位像上标记辅助线，测量并比较CAJ至右侧第6、7后肋、第6/7后肋间隙、气管隆嵴及心右缘上下段交界点的距离。结果 A组136例次（136/183，74.32%）导管尖端清楚显示，43例次（43/183，23.50%）隐约可见，4例次（4/183，2.19%）未显示；B组依次为131例次（131/334，39.22%）、169例次（169/334，50.60%）及34例次（34/334，10.18%）。A组导管尖端清楚显示率高于B组，未显示率低于B组（χ2=59.65，P<0.01）。CAJ至右侧第6后肋、右侧第6/7后肋间隙、右侧第7后肋、气管隆嵴及心右缘上下段交界点的距离分别为-1.95~7.51 cm、-2.82~6.44 cm、-3.91~5.00 cm、1.19~6.58 cm及-1.12~1.43 cm，平均（3.50±1.78）cm、（2.38±1.76）cm、（1.18±1.75）cm、（3.84±1.01）cm及（0.11±0.05）cm，总体差异有统计学意义（F=75.54，P<0.01）；两两比较，CAJ至右侧第6后肋距离与至气管隆嵴距离差异无统计学意义（P>0.05），其余距离间差异均有统计学意义（P均<0.05）。CAJ与心右缘上下段交界点距离最短，以通过该交界点的水平线上垂直2 cm范围内为PICC导管尖端的理想位置。结论 胸椎正位片能清晰显示PICC导管尖端。心右缘上下段交界点水平线上垂直2 cm范围内为PICC导管尖端的理想位置。 |
| 英文摘要: |
| Objective To evaluate the value of frontal thoracic spine X-ray film for tip positioning after implantation of peripherally inserted central catheter (PICC). Methods Totally 114 patients received PICC were retrospectively analyzed. All patients underwent at least once chest X-ray radiography, frontal thoracic spine X-ray radiography and chest CT after implantation of PICC. Group A included 183 times of frontal thoracic spine radiography, while group B included 334 times of frontal chest radiography. Then mediastinal window chest CT images were reconstructed on the axial, coronal and sagittal plane. Position of the superior vena cava and cavoatrial junction (CAJ) as well as corresponding axis level images were assessed with multi-section observation. The position of CAJ was determined, and auxiliary lines were marked on the positioning image. Then the distance between CAJ to the right 6th, 7th posterior rib, the right intercostal space of 6-7th posterior ribs, the tracheal protuberance, the junction of the right upper and lower cardiac margins were measured and compared. Results The tip of catheter was clearly displayed on 136 times (136/183, 74.32%), indistinctly showed on 43 times (43/183, 23.50%) but not detected on 4 times (4/183, 2.19%) radiographies in group A, which was 131 times (131/334, 39.22%), 169 times (169/334, 50.60%) and 34 times (34/334, 10.18%) radiographies in group B. The rate of clear display tips in group A was higher than that in group B, and the rate of no display tips in group A was lower than that in group B (χ2=59.65, P<0.01). The distance of CAJ to the right 6th, 7th posterior rib, the right intercostal space of 6-7th posterior ribs, the tracheal protuberance, the junction of the right upper and lower cardiac margins was -1.95-7.51 cm, -2.82-6.44 cm, -3.91-5.00 cm, 1.19-6.58 cm and -1.12-1.43 cm, respectively; the average value was (3.50±1.78) cm, (2.38±1.76) cm, (1.18±1.75) cm, (3.84±1.01) cm and (0.11±0.50) cm, respectively (F=75.54, P<0.01). Pairwise comparison showed that there was no statistical difference of distance between CAJ to the right 6th posterior rib and to the tracheal protuberance (P>0.05), while the other distances were all statistically different (all P<0.05). The distance of CAJ to the junction of the right upper and lower cardiac margins was the shortest, and within upper 2 cm of the horizontal line pass the above junction was the ideal range of the position of tip of PICC. Conclusion Frontal thoracic spine X-ray might clearly display the tip of PICC. Within upper 2 cm of the horizontal line pass the junction of the right upper and lower cardiac margins was the ideal position of the tip of PICC. |
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