超声引导下中心静脉置管术后还需要常规拍CXR定位吗？| 引经据典[12] · 协和呼吸

本/期/解/读

超声引导下深静脉置管术后常规行胸片来定位还是明智之选吗?

——一项基于6875例患者的回顾性分析结果

Is Routine Chest X-Ray After Ultrasound-Guided Central Venous Catheter Insertion Choosing Wisely?: A Population-Based Retrospective Study of 6,875 Patients

关键词

中心静脉置管，胸片，广泛应用，错位，气胸，超声显像

作者：

Chui J, et. al

翻译：

北京协和医院呼吸内科  孙宇新 黄慧

文献来源：

Chest. 2018 Jul;154(1):148-156.

DOI:

10.1016/j.chest.2018.02.017

  背    景  

胸片（CXR）是中心静脉置管术（CVC）后的常规检查，本研究拟评价超声引导下CVC术后行CXR的价值。

  方    法  

本研究是一项回顾性队列研究，纳入2008年7月1日至2015年12月31日在该院手术室行CVC操作的成人患者。通过CXR评价超声引导下CVC后气胸、静脉置管错位的发生率。通过回归分析来评价这一操作的上述潜在并发症，并通过成本分析来评价CXR的经济成本。

  结    果  

这期间共有18247例患者接受CVC操作，其中6875例纳入本研究。气胸和静脉置管错位的发生率分别是0.33%/25例[95%可信区间(CI) 0.22-0.5]、1.91%/131例（95% CI 1.61-2.26）（置入右房22例，共70例患者的置管在上腔静脉、锁骨下静脉及无名静脉中打折，39例在左静内静脉/右静内静脉内打折）。将拟置管的深静脉位置与上述并发症的相关性做进一步分析，发现：左锁骨下静脉置管是最易导致气胸的部位[OR 6.69, (95%CI 2.45-18.28), p<0.01],右颈内静脉以外的其他部位的静脉置管容易发生静脉置管错位。术后常规的CXR检查年花费是（105000-183000）$。

  结    论  

超声引导下静脉置管术后发生气胸、置管错位的发生率低，而常规的CXR的花费则不菲。作者认为没必要把CXR检查作为本院超声引导下静脉置管术后的常规检查。

原文摘要

BACKGROUND

A routine chest radiograph (CXR) is recommended as a screening test after central venous catheter (CVC) insertion. The goal of this study was to assess the value of a routine postprocedural CXR in the era of ultrasound-guided CVC insertion.

METHODS

This population-based retrospective cohort study was performed to review the

records of all adult patients who had a CVC inserted in the operating room in a tertiary institution between July 1, 2008, and December 31, 2015. We determined the incidence of pneumothorax and catheter misplacement after ultrasound-guided CVC insertion. A logistic regression analysis was performed to examine the potential risk factors associated with these complications, and a cost analysis was conducted to evaluate the economic impact.

RESULTS

Of 18,274 patients who had a CVC inserted, 6,875 patients were included. The overall incidence of pneumothorax and catheter misplacement was 0.33% (95% CI, 0.22-0.5) (23 patients) and 1.91% (95% CI, 1.61-2.26) (131 patients), respectively. The site of catheterization was the major determinant of pneumothorax and catheter misplacement; left subclavian vein catheterization was the site at a higher risk for pneumothorax (OR, 6.69 [95% CI, 2.45-18.28]; P < .001), and catheterization sites other than the right internal jugular vein were at a higher risk for catheter misplacement. Expenditures on routine postprocedural CXR were US $105,000 to $183,000 per year at our institution.

CONCLUSIONS

This study found that pneumothorax and catheter misplacement after ultrasound-guided CVC insertion were rare, and the costs of a postprocedural CXR were exceedingly high. We concluded that a routine postprocedural CXR is unnecessary and not a wise choice in our setting.

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作者介绍

孙宇新

北京协和医院呼吸内科硕士在读

北京协和医院呼吸内科2018级硕士研究生，所在课题组主要从事间质性肺病方向的临床和基础研究。

往期经典

文字来源：孙宇新   黄 慧

栏目负责：黄    慧

版面编辑：陈珂琪

图片来源：部分来源于网络，如有侵权，请联系删除

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