超声心动图改善儿童PICC尖端右心异位的评估研究

目的X线检查对于儿童经外周静脉置入中心静脉导管（peripherally inserted central catheter,PICC）尖端定位、尤其右心异位者具有一定局限性。本研究探讨超声心动图对于改善儿童PICC尖端右心系统异位显示的价值。 方法选择进行PICC置管的患儿96例，采用自身对照，分别行胸部正位X线检查及超声心动图检查确定PICC尖端位置，观察超声心动图对于PICC尖端右心系统异位评估的改善价值。 结果超声心动图与胸部正位X线检查的PICC尖端右心系统异位检出率分别为22.9%及7.3%。χ2检验离散性结果显示2种方法离散性差异有统计学意义（χ2=9.13,P=0.003），超声心动图定位方法右心系统异位检出率高于胸部X线检查。Kappa检验一致性结果显示两种方法一致性较低（Kappa=0.16）。超声心动图定位方法右心系统异位检出敏感度为79%，ROC曲线下面积为0.830（P＜0.05），95%置信区间为（0.692~0.968）。 结论超声心动图检查可明显提高儿童PICC尖端右心系统异位检出率，儿童进行PICC置管时，若胸部正位X线检查疑存在右心系统异位应常规补充超声心动图检查。

Evaluation of echocardiography in improving ectopic tip of PICC in right heart of children

ObjectiveX-ray examination has some limitations in the tip positioning of peripherally inserted central catheter(PICC) in children, especially in patients with ectopic tip in right heart. The purpose of this study is to explore the value of echocardiography in improving the display of ectopic tip of PICC in right heart system in children. MethodsA total of 96 patients who underwent PICC catheterization successfully were selected. Self-control trial was applied and chest X-ray and echocardiography were used respectively to confirm the tip position of PICC. The value of echocardiography in improving the evaluation of ectopic tip of PICC in right heart system was observed. ResultsThe detection rate of ectopic tip of PICC in right heart by echocardiography and chest X-ray was 22.9% and 7.3% respectively. The results of Chi-square test showed that there was significant difference in dispersion between two methods(χ2=9.13, P=0.003). The detection rate of ectopic tip of PICC in right heart system by echocardiography was higher than that by chest X-ray. The consistency result of Kappa test showed that the consistency of the two methods was low(Kappa=0.16). The sensitivity of echocardiographic localization of ectopic tip of PICC in right heart system was 79%, the area under ROC 〖JP2〗curve was 0.830(P＜0.05) and the 95% confidence interval was(0.692-0.968). 〖JP〗 ConclusionEchocardiography can significantly improve the detection rate of ectopic tip of PICC in right heart in children.During PICC catheterization in children, routine echocardiographic examination should be performed if the patient is suspected of having ectopia in right heart system by chest X-ray examination.