CAJ | 학술논문

目的：探讨中心静脉导管与压力传感器之间加入三通接头的数量对患者中心静脉压（CVP）数值的影响。方法采用前瞻性对照研究方法，将2014年2月至10月天津市第五中心医院重症医学科行CVP监测的患者作为研究对象。根据中心静脉导管与压力传感器之间放置三通接头的数量分为0（对照组）1、2、3个三通接头组。测得同一患者放置不同数量三通接头时相应的CVP数值，在监护仪上获取方波图形并保存，通过测量方波后震荡波的两次振动周期间距离和震荡波振幅，计算测压系统的自身频率（fn）和衰减系数（D），比较各组CVP、 fn和D的差异。结果共收集20例患者150例次的测定数据。①随着三通接头数量增加，CVP呈逐渐降低趋势，0、1、2、3个三通组CVP分别为（7.00±1.60）、（7.00±3.00）、（5.00±2.00）、（4.00±1.00）mmHg（1 mmHg＝0.133 kPa），只有3个三通组CVP明显低于对照组（F＝9.333，P＝0.015），其他组两两比较差异均无统计学意义。②随着三通接头数量增加，fn呈逐渐增高趋势，0、1、2、3个三通组fn分别为（12.30±0.79）、（16.00±0.91）、（18.10±1.75）、（20.90±2.69）Hz。1、2、3个三通组fn均明显高于对照组（F1＝45.962，F2＝45.414，F3＝46.830，均P＝0.000）；2个和3个三通组fn明显高于1个三通组（F1＝5.827， P1＝0.042；F2＝15.038，P2＝0.004），但2个和3个三通组间比较差异无统计学意义（F＝3.800，P＝0.087）。③随着三通接头数量增加，D亦呈逐渐增高趋势，0、1、2、3个三通组D值分别为1.62±0.27、1.60±0.22、1.82±0.25、2.15±0.58，4组间两两比较差异均无统计学意义。结论在中心静脉导管与压力传感器之间加入三通接头后，CVP数值会被低估，其原因考虑与三通接头造成了整个压力传感器的长度增加和管腔变细有关。
목적：탐토중심정맥도관여압력전감기지간가입삼통접두적수량대환자중심정맥압（CVP）수치적영향。방법채용전첨성대조연구방법，장2014년2월지10월천진시제오중심의원중증의학과행CVP감측적환자작위연구대상。근거중심정맥도관여압력전감기지간방치삼통접두적수량분위0（대조조）1、2、3개삼통접두조。측득동일환자방치불동수량삼통접두시상응적CVP수치，재감호의상획취방파도형병보존，통과측량방파후진탕파적량차진동주기간거리화진탕파진폭，계산측압계통적자신빈솔（fn）화쇠감계수（D），비교각조CVP、 fn화D적차이。결과공수집20례환자150례차적측정수거。①수착삼통접두수량증가，CVP정축점강저추세，0、1、2、3개삼통조CVP분별위（7.00±1.60）、（7.00±3.00）、（5.00±2.00）、（4.00±1.00）mmHg（1 mmHg＝0.133 kPa），지유3개삼통조CVP명현저우대조조（F＝9.333，P＝0.015），기타조량량비교차이균무통계학의의。②수착삼통접두수량증가，fn정축점증고추세，0、1、2、3개삼통조fn분별위（12.30±0.79）、（16.00±0.91）、（18.10±1.75）、（20.90±2.69）Hz。1、2、3개삼통조fn균명현고우대조조（F1＝45.962，F2＝45.414，F3＝46.830，균P＝0.000）；2개화3개삼통조fn명현고우1개삼통조（F1＝5.827， P1＝0.042；F2＝15.038，P2＝0.004），단2개화3개삼통조간비교차이무통계학의의（F＝3.800，P＝0.087）。③수착삼통접두수량증가，D역정축점증고추세，0、1、2、3개삼통조D치분별위1.62±0.27、1.60±0.22、1.82±0.25、2.15±0.58，4조간량량비교차이균무통계학의의。결론재중심정맥도관여압력전감기지간가입삼통접두후，CVP수치회피저고，기원인고필여삼통접두조성료정개압력전감기적장도증가화관강변세유관。
ObjectiveTo investigate the influence of the number of T-junctions between central venous catheter and pressure transducer on measurement of central venous pressure (CVP) in patients.Methods A prospective controlled study was conducted. The patients with CVP monitoring in Department of Critical Care Medicine of the Fifth Center Hospital in Tianjin from February to October in 2014 were enrolled. The patients were divided into three groups according to the number of T-junction between central venous catheter and pressure transducer: without T-junction control group and 1, 2, 3 T-junctions groups. In each patient, corresponding CVP values with different number of T-junctions placed between the central venous catheter and pressure sensors were determined within a certain period, and a square-wave graphic was obtained and preserved on the monitor. The own frequency (fn) and the attenuation coefficient (D) of the system of pressure measurement were calculated after measurement of the shock wave following a square-wave to obtain the distance between two vibrations and the amplitude of the shock wave. The difference in CVP, fn and D were compared among the groups.Results A total of 20 cases were enrolled, and 150 groups of data were collected.① With the increase in the number of T-junction, CVP showed a tendency of gradual reduction. The CVP of the groups of control and 1, 2, 3 T-junctions was (7.00±1.60), (7.00±3.00), (5.00±2.00), and (4.00±1.00) mmHg (1 mmHg = 0.133 kPa), respectively. The CVP of 3 T-junctions group was significantly lower than that of the control group (F = 9.333,P = 0.015).② With an increase in the number of T-junction, fn showed a tendency of gradual increase. The fn of groups control and 1, 2, 3 T-junctions was (12.30±0.79), (16.00±0.91),(18.10±1.75), (20.90±2.69) Hz, respectively. The fn of 1, 2, 3 T-junctions group was significantly higher than that of the control group (F1 = 45.962,F2 = 45.414,F3 = 46.830, allP = 0.000); the fn of groups 2 and 3 T-junctions was significantly higher than that of 1 T-junction group (F1 = 5.827,P1 = 0.042;F2 = 15.038,P2 = 0.004), but there was no significant difference between the groups of 2 T-junctions and 3 T-junctions (F = 3.800,P = 0.087).③ With an increase of the number of T-junction, D also showed a tendency of gradual increase. The D of 1, 2, 3 T-junction group was 1.62±0.27, 1.60±0.22, 1.82±0.25, and 2.15±0.58, respectively. There were no differences among four groups.ConclusionAfter the application of T-junctions between central venous catheter and pressure transducer, CVP values will be underestimated, the reason of which is considered to be the increase in length and thinner lumen of the T-junctions.