食管超声心动图构建右颈内中心静脉置入导管深度的简易预测公式

目的经右颈内静脉置入中心静脉导管,采用经食管超声心动图(TEE)准确定位导管位置,构建置入导管深度简易预测公式。方法选择择期行心脏手术患者172例,男101例,女71例,年龄18岁。于麻醉诱导后放置TEE探头,经右颈内静脉穿刺置入导丝,初次导丝置入深度为Peres公式计算深度(身高÷10 cm),TEE观察导丝尖端是否位于合适区域内(上腔静脉右心房入口上2 cm至入口下1 cm)。根据观察结果调整深度,使导丝尖端位于理想位置(上腔静脉右心房入口上1 cm处)。沿导丝送入中心静脉导管,置入导管深度等于此时置入导丝深度。记录性别、身高、体重、BMI、置入导管深度、Peres公式计算深度以及穿刺置管相关并发症。结果 TEE观察下根据Peres公式计算深度置管,有126例导丝尖端位于合适区域内,46例导丝尖端不在合适区域内,置入导管深度合适比例为73.3%。172例患者的Peres公式计算深度明显深于置入导管深度(16.5±0.8)cm vs(14.9±1.2)cm,P0.01]。男性身高明显高于女性,体重明显重于女性,Peres公式计算深度、置入导管深度明显深于女性(P0.01)。男、女性患者Peres公式计算深度均明显深于置入导管深度(P0.01)。身高与置入导管深度相关,采用回归方程进行相关分析,得出在环状软骨水平行右颈内中心静脉穿刺,置入导管深度(cm)=身高(cm)÷10-1.5(r~2=0.437,P0.01)。17例患者出现心律失常,未观察到误穿动脉、血肿形成、气胸等现象。结论对于我国成年患者行右颈内中心静脉置管,Peres公式计算深度有一定局限性,利用TEE完成置管安全有效。所构建的简易预测公式男女均适用,可为临床操作提供参考。

A clinical study of establishing a simple formula model for predicting the depth of catheterization through the right internal jugular vein by using transesophageal echocardiography

Objective Placing the central venous catheter through the right internal jugular vein, and using transesophageal echocardiography (TEE), to accurately locate the catheter position and construct a simple prediction model for the depth of the catheter.
Methods One hundred and seventy two patients undergoing elective cardiac surgery, 101 males and 71 females, aged > 18 years, were placed with a TEE probe after induction of anesthesia, and a central venous guidewire was inserted through the right internal jugular vein. The primary guidewire was inserted at a depth calculated by the Peres formula (height ÷ 10 cm). TEE was used to observe whether the tip of the guidewire was in the suitable area (2 cm above and 1cm below the right atrium entrance of the superior vena cava). The depth was adjusted according to the observation results so that the tip of the guidewire was at the ideal position (1 cm above the right atrium entrance of the superior vena cava). The central venous catheter was guided along the guidewire, and the depth of the catheter was equal to the depth of the guidewire. Gender, height, weight, and BMI of patients were recorded. The depths of the catheter and the Peres formula results were recorded.
Results Under the TEE observation, according to Peres formula, 126 guidewire tips were located in the appropriate area, and 46 guidewire tips were not in the appropriate area, the appropriate proportion was 73.3%. The average depth of the catheter was significantly shorter than that calculated by Peres formula (16.5 ± 0.8) cm vs (14.9 ± 1.2) cm, P < 0.01]. Compared with female patients, the height, weight, depth calculated by the Peres formula and depth of catheter in male patients increased significantly (P < 0.01).The height was related to the depth of catheter (P < 0.01). Using Regression equation, the correlation between the depth of catheter and height was analyzed, this study found that when right internal jugular central venipuncture was performed at the horizontal position of the cricoid cartilage, the depth of the catheter (cm)=height (cm) ÷10 - 1.5 (r²= 0.437, P < 0.01). There were 17 patients of arrhythmia, but artery puncture by mistake, hematoma formation, and pneumothorax were not observed.
Conclusion For adults with right internal jugular vein catheterization, Peres formula has limitations in calculating the depth of catheter, while TEE can be used safely and effectively. The simple prediction model constructed by TEE in this study can be used as a clinical reference.