CAJ | 학술논문

目的：探讨成人上腔静脉的 X线解剖学标志及其在经外周静脉置入中心静脉导管(PICC)末端定位中的应用价值。方法回顾性分析219例PICC置管患者的胸片,其中57例患者1周内行胸部CT检查,测量并记录气管隆突至心影右上缘或心房腔静脉连接处(CAJ)、右支气管角以及PICC导管末端的垂直距离,将所得数据进行统计分析。57例患者胸片和 CT中所测的数据分为胸片组和CT组并对2组进行统计分析。结果胸片组患者的气管隆突至CAJ、右支气管角和PICC导管末端的距离和CT组的差异均无统计学意义(P值均>0.05),胸片组的以上3组测量值和 CT组存在正相关关系(r=0.744,0.332,0.778,P 值均<0.05)。胸片组判断PICC导管末端位置情况与CT组判断的差异无统计学意义(P值>0.05),2组的吻合系数k=0.542,吻合度有统计学意义(P值<0.05)。219例患者胸片中气管隆突至心影右上缘的平均垂直距离为(3.21±0.84)cm；气管隆突至右支气管角的平均垂直距离为(1.38±0.28)cm,以上测量值男性均高于女性(P 值<0.05)。结论采用气管隆突、右支气管角及心影右上缘作为成人上腔静脉和PICC导管末端 X线定位的影像学标志科学且准确。气管隆突至右支气管角、心影右上缘的平均距离可作为临床判断PICC导管末端位置的参考依据。
목적：탐토성인상강정맥적 X선해부학표지급기재경외주정맥치입중심정맥도관(PICC)말단정위중적응용개치。방법회고성분석219례PICC치관환자적흉편,기중57례환자1주내행흉부CT검사,측량병기록기관륭돌지심영우상연혹심방강정맥련접처(CAJ)、우지기관각이급PICC도관말단적수직거리,장소득수거진행통계분석。57례환자흉편화 CT중소측적수거분위흉편조화CT조병대2조진행통계분석。결과흉편조환자적기관륭돌지CAJ、우지기관각화PICC도관말단적거리화CT조적차이균무통계학의의(P치균>0.05),흉편조적이상3조측량치화 CT조존재정상관관계(r=0.744,0.332,0.778,P 치균<0.05)。흉편조판단PICC도관말단위치정황여CT조판단적차이무통계학의의(P치>0.05),2조적문합계수k=0.542,문합도유통계학의의(P치<0.05)。219례환자흉편중기관륭돌지심영우상연적평균수직거리위(3.21±0.84)cm；기관륭돌지우지기관각적평균수직거리위(1.38±0.28)cm,이상측량치남성균고우녀성(P 치<0.05)。결론채용기관륭돌、우지기관각급심영우상연작위성인상강정맥화PICC도관말단 X선정위적영상학표지과학차준학。기관륭돌지우지기관각、심영우상연적평균거리가작위림상판단PICC도관말단위치적삼고의거。
Objective To explore X-ray anatomical landmarks of adult superior vena cava and their applications for localizing cath-eter tip of PICC placement.Methods The authors retrospectively reviewed chest radiographs of 2 1 9 PICC insertions,and 5 7 of them were carried out with chest CT scan in a week.For each patient,the vertical distances from the carina to the right superior heart bor-der or the cavoatrial j unction(CAJ),the right tracheobronchial angle and PICC tip position were measured,recorded,and analyzed, respectively.The obtained data from 5 7 patients were divided into chest X-ray group and CT group,which were then statistically an-alyzed accordingly.Results Between chest X-ray group and CT group,the vertical distances from the carina to CAJ,the right tra-cheobronchial angle and PICC tip position had no significant difference (each P>0.05)and showed positive correlation(r=0.744, 0.332,0.778,each P<0.05).No significant difference existed in PICC catheter tip locations estimated by chest X-ray group and by CT group (P>0.05).The matching coefficient was k=0.542 and was statistical difference (P<0.05).The mean vertical distance from the carina to the right superior heart border was (3.21±0.84)cm and from the carina to the right tracheobronchial angle was (1.38±0.28)cm.The above measured values in males were higher than in females(P<0.05).Conclusion It is applicable and ac-curate that using the carina,right tracheobronchial angle and right superior heart border as the radiographic landmarks for adult supe-rior vena cava and catheter tip positioning of PICC placement.The average vertical distances from the carina to the right tracheo-bronchial angle,and to the right superior heart border in the chest X-rays can provide reference basis for j udging PICC catheter end position in clinical.