经胸超声心动图在观察长期颈内静脉血透导管尖端中的应用

doi:DOI:10.12117/jccmi.2018.12.007

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摘要目的：探讨经胸超声心动图（TTE）在观察长期颈内静脉血透导管尖端中的应用。方法：选取我院2016年1月—2017年7月收治的长期经颈内静脉血透导管行血液透析患者52例，分别行胸部X线及TTE检查，观察导管尖端的情况，包括其位置及有无血栓形成等并发症。结果：52例患者中，49例导管尖端在TTE中清晰显示，占94.2%，导管尖端定位到位率87.8%（43/49）、尖端异位率12.2%（6/49）。48例导管尖端在胸部X线中清晰显示，占92.3%，导管尖端定位到位率89.6%（43/48）、尖端异位率10.4%（5/48），差异无统计学意义（P＞0.05）；经Kappa检验一致性较好（P＜0.05）。TTE显示导管尖端血栓形成14例，X线未能显示血栓形成。对于异位严重的病例，在TTE指导下可退管至理想位置，退管成功率100%。对于长期颈内静脉血透导管血栓形成的患者，可指导临床溶栓治疗。结论：TTE能够较清晰地显示长期颈内静脉血透导管尖端，观察其位置及有无血栓形成，帮助临床及时调整导管尖端异位及评价溶栓效果，具有无创、简便、安全、快速、准确的特点，具有重要的临床应用价值。

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	罗丽
	庞广保
	赵毅兰
	甘小玲
	沈洁
	潘艳

关键词 ：颈静脉, 肾透析, 超声心动描记术

Abstract：Objective: To explore the value of transthoracic echocardiography(TTE) on observation the catheter tip of the internal jugular vein long-termcatheter in hemodialysis patients. Methods: From January 2016 to July 2017, 52 hemodialysis patients with the internal jugular vein long-termcatheter undertook TTE and X-ray, to observe the catheter tip, including its position, and other complication such as thrombosis. Results: In the 52 cases, catheter tips of 49 cases could be observed clearly by TEE(94.2%). Cathetertip localization rate was 87.8%(43/49), ectopic rate was 12.2%(6/49); while catheter tips of 48 cases could be observed clearly by X-ray(92.3%), the cathetertip localization rate was 89.6%(43/48), and ectopic rate was 10.4%(5/48). There was no statistically significant difference(P>0.05). Kappa test showed a better consistence(P<0.05). Thrombosis was found in fourteen catheter tips by TTE, while none could be found by X-ray. All the ectopic severe cases were retreated to ideal position under the guidance of TTE, and the success rate was 100%. For the thrombosis patients, treatment of thrombolysis was guided. Conclusion: TTE can clearly display catheter tip, observe its position and the presence of thrombus. It can help to adjust ectopic catheter tip and evaluate thrombolysis effect. It’s noninvasive, convenient, safe, rapid and accurate. It shows an important clinical value.

Key words： Jugular veins Renal dialysis Echocardiography

PACS:	Ｒ322.123
	Ｒ459.5
	Ｒ540.45

基金资助:广西医药卫生自筹经费计划课题（No. Z20180696）。

通讯作者: 庞广保，广西壮族自治区人民医院重症医学科，530021。

作者简介: 罗丽（1983-），女，广西南宁人，主治医师。

引用本文:

罗丽，庞广保，赵毅兰，甘小玲，沈洁，潘艳. 经胸超声心动图在观察长期颈内静脉血透导管尖端中的应用[J]. 中国临床医学影像杂志, 2018, 29(12): 866-868.
LUO Li, PANG Guang-bao, ZHAO Yi-lan, GAN Xiao-ling, SHEN Jie, PAN Yan. The value of transthoracic echocardiography on observation of the catheter tip of the internal jugular vein long-termcatheter in hemodialysis patients. JOURNAL OF CHINA MEDICAL IMAGING, 2018, 29(12): 866-868.

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http://www.jccmi.com.cn/CN/DOI:10.12117/jccmi.2018.12.007 或 http://www.jccmi.com.cn/CN/Y2018/V29/I12/866