心脏超声微泡造影判断中心静脉导管尖端位置的临床价值

沈鹏; 赵连泽; 安友仲; 吕杰; 赵慧颖

doi:10.3969/j.issn.2095-5227.2022.11.006

心脏超声微泡造影判断中心静脉导管尖端位置的临床价值

Clinical value of echocardiography with microbubble contrast agent in determining position of tip of central venous catheter

摘要

摘要:
背景中心静脉置管后常规需行胸片检查来明确导管尖端位置，但此方法相对耗时且具有放射危害，因而本研究尝试采用床旁超声快速判断导管尖端位置。
目的评估心脏超声微泡造影技术快速判断中心静脉导管位置的有效性。
方法前瞻性纳入2020年7月- 2021年6月于北京大学人民医院重症医学科行中心静脉置管的重症患者。应用振荡微泡0.9%氯化钠注射液灌注心脏超声造影技术判断中心静脉导管尖端的位置。收集患者的一般资料、超声造影相关指标和胸片相关指标，并将置管位置和检查结果与金标准床旁胸片比较。
结果该研究共入组74例患者，男33例，女41例，年龄为(67.3 ± 19.3)岁。应用床旁心脏超声造影判断中心静脉导管位置仅耗时7.2 min (95% CI：6.6 ~ 7.9)，胸片判断中心静脉导管用时77.8 min (95% CI：69.0 ~ 86.6)，两者差异有统计学意义(P＜0.001)。以床旁胸片作为金标准，心脏超声微泡造影判断导管位置的敏感度为100%，特异性为85.7%，准确率为98.65%。床旁超声与胸片判断中心静脉导管位置结果一致性无统计学差异(Kappa=0.916)。
结论与床旁胸片相比，心脏超声微泡造影技术对中心静脉导管位置的判断准确性高，并且更加快速，为危重患者的救治争取了宝贵的时间。

Abstract:
Background After catheterization of the central vein, chest X-ray (CXR) is routinely required to determine the position of catheter tip. However, this method is time-consuming and radioactive. Therefore, this study tries to use bedside ultrasound to quickly determine the position of catheter tip.
Objective To evaluate the effectiveness of using echocardiography with microbubble contrast agent to determine the position of central venous catheter (CVC).
Methods Prospective inclusion of critically ill patients who underwent central venous catheterization in the Department of Intensive Care Medicine (ICU) of Peking University People’s Hospital from July 2020 to June 2021 was performed. Oscillating microbubble saline perfusion contrast-enhanced echocardiography technique was applied to determine the position of the central venous catheter tip. Then the patient's general information, contrast echocardiography related indicators and chest X-ray related indicators were collected, and the results of tube placement and examination time with the bedside CXR were compared.
Results A total of 74 patients were enrolled in this study, including 33 males and 41 females with an average age of (67.3 ± 19.3) years. It took only 7.2 minutes (95% CI: 6.6-7.9) to judge the position of central venous catheter by bedside cardiac contrast echocardiography, and 77.8 minutes (95% CI: 69.0-86.6) by chest radiograph, and the difference was significant (P<0.05). Compared to the chest radiograph, the sensitivity of bedside cardiac contrast echocardiography was 100%, specificity 85.7%, and accuracy 98.65%. There was no significant difference for confirming the central venous catheter position between the two diagnostic methods (Kappa=0.916).
Conclusion Compared with CXR, the echocardiography with microbubble contrast agent can be used to determine the position of CVC with accuracy, and it saves time for further clinical treatment.

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