早产儿经大隐静脉行PICC置管最佳置管深度的临床研究

A clinical study on the optimal placement depth for peripherally inserted central catheter through the great saphenous vein in preterm infants

摘要:

目的 分析早产儿经大隐静脉（great saphenous vein, GSV）行经外周静脉穿刺的中心静脉导管（peripherally inserted central venous catheter, PICC）置管最佳置管深度（optimal placement depth, OPD）与体格测量参数之间的相关性，以期建立经GSV PICC置管OPD的预测公式。方法 回顾性选取2022年12月—2024年2月在中南大学湘雅三医院新生儿重症监护室经GSV PICC置管的早产儿为研究对象。按穿刺部位不同［膝关节（knee joint, KJ）或踝关节（ankle joint, AJ）GSV］，分为GSV-KJ置管组（38例）和GSV-AJ置管组（33例）。测量置管时体重（body weight, BW）、身长、上部量、下部量、头围、腹围，应用Pearson相关分析评估上述变量与OPD的相关性，构建早产儿经GSV PICC置管OPD的预测公式，比较传统预估公式和新预测公式的预测深度与理想的OPD之间的预测残差。结果 Pearson相关分析显示，GSV-KJ置管组和GSV-AJ置管组PICC OPD与BW、身长、上部量、下部量、头围、腹围呈显著正相关（均P<0.05），两组中其与BW的相关性均最高；一元线性回归分析显示，GSV-KJ置管组和GSV-AJ置管组PICC置管OPD与BW呈线性关系。OPD预测方程分别为：GSV-KJ PICC置管OPD（cm）=13.1+2.7×BW（kg），GSV-AJ PICC置管OPD（cm）=13.4+6.0×BW（kg）；新预测公式的预测残差显著小于传统预估公式（P<0.05）。结论 早产儿经GSV PICC置管OPD与BW呈正相关，依据BW构建的新预测公式的预测结果更接近理想的OPD。

Abstract:

Objective To investigate the correlation between optimal placement depth (OPD) and physical measurement parameters in preterm infants receiving placement of peripherally inserted central catheter (PICC) through the great saphenous vein (GSV), and to establish a predictive formula for OPD during the placement of PICC through the GSV.Methods A retrospective analysis was performed for the preterm infants who received the placement of PICC through the GSV in the Neonatal Intensive Care Unit of the Third Xiangya Hospital of Central South University from December 2022 to February 2024. According to the site of puncture [GSV of the knee joint (KJ) or the ankle joint (AJ)], they were divided into a GSV-KJ placement group (n=38) and a GSV-AJ placement group (n=33). The infants were measured in terms of body weight (BW), body length, the length of the upper and lower parts of the body, head circumference, and abdominal circumference at the time of placement. The Pearson correlation analysis was used to investigate the correlation between the above variables and OPD. A predictive formula was established for OPD in the placement of PICC via the GSV in preterm infants, and the predicted residual between the predicted depth and the ideal OPD was compared between the conventional predictive formula and the new predictive formula.Results The Pearson correlation analysis showed that PICC OPD was significantly positively correlated with BW, body length, the length of the upper and lower parts of the body, head circumference, and abdominal circumference in both the GSV-KJ placement group and GSV-AJ placement group (P<0.05), with the highest degree of correlation between OPD and BW. The univariate linear regression analysis showed a linear relationship between PICC OPD and BW in both groups. The predictive formulas for OPD were as follows: GSV-KJ PICC OPD (cm) = 13.1 + 2.7 × BW (kg) and GSV-AJ PICC OPD (cm) = 13.4 + 6.0 × BW (kg), and the new predictive formulas had a significantly lower predicted residual than the conventional predictive formula (P<0.05).Conclusions OPD for PICC through the GSV is positively correlated with BW, and the prediction results of the new predictive formula based on BW are closer to the ideal OPD.