两种体表测量法在PICC置管深度评估中的效果比较

目的探讨PICC导管末端置于体内最适位置的最佳体外测量方法。方法将86例行PICC置管患者随机分为观察组和对照组各43例。观察组采用从右上肢穿刺点至右胸锁关节＋4cm，或者从左上肢穿刺点至右胸锁关节＋4cm的测量法，对照组采用从穿刺点至右胸锁关节，再向下反折至第3肋间的测量法，置管到达测量长度后，摄胸部X线片定位。比较两组PICC导管末端置入上腔静脉及置于最适位置的成功率、置管长度。结果观察组置入最适位置36例，成功率92．31％，置入上腔静脉39例，成功率90．70％；对照组置入最适位置12例，成功率38．71％，置入上腔静脉31例，成功率72．09％。观察组PICC导管置入上腔静脉及最适深度的成功率显著高于对照组，差异有统计学意义（χ^2分别为3．785，4．572；P〈0．05），观察组和对照组两组测得置管长度分别为（48．43±3．20），（50．46±3．20）cm，与实际置管长度差异无统计学意义（t分别为1．024，1．509；P〉0．05）。结论采用从右上肢穿刺点至右胸锁关节＋4cm，从左上肢穿刺点至右胸锁关节＋4cm的测量方法准确，可提高PICC置管的成功率。

Effect comparison of two different external measurement methods on the optimal location of PICC

Objective - To explore the optimal way of external measurement method in the optimal depth of PICC. Methods Eighty-six patients who received PICC were randomly divided into observation group （n = 43 ） and control group （ n = 43 ）. In the observation group, the external measurement was adopted that measured the distance from the puncture point of right arm to the right sternoclavicular joint or from the puncture point of left arm to the right sternoclavicular joint, then plus 4 cm. In the control group, the external measurement was adopted that measured the distance from the puncture point of right arm to the right sternoclavicular joint, and then vertically backed to the point between the third and the fourth rib. X-ray film was taken in two groups after the catheter was introduced and the distance was measured. The success rate of optimal depth of PICC end and superior vena cava, and inserted length of two groups were observed and compared. Results The inserted length of the observation group and the control group was （48.43 ± 3.20） cm and （50.46 ± 3.20） cm, respectively, and the actual inserted length of the observation group and the control group was （47.83 ± 3.50） and （49.67 ± 3.30） cm, and the differences were not statistically significant （ t = 1. 024,1. 509 ; P 〉 0.05 ）. The success rate of superior vena cava inserted and optimal depth of the end of PICC of the control group was 90.70% （39 cases） and 92.31% （31 cases）, respectively, and that of the control group was 72.09% （36 cases）and 38.71% （ 12 cases）, and the differences were statistically significant （χ^2 = 3. 785,4. 572 ;P 〈 0.05）. Conclusions The external measurement measuring the distance from the puncture point of right arm to the right sternoclavicular joint or from the puncture point of left arm to the right sternoclavicular joint, then plus 4 cm is one accurate measure method,which can improve the success inserted rate of PICC.