超声尖端定位和传统体表测量法与“金标准”X线在新生儿PICC置管中的一致性比较-现代医学

超声尖端定位和传统体表测量法与“金标准”X线在新生儿PICC置管中的一致性比较

单位：1. 中山大学附属第一医院新生儿科, 广东广州 510000;
2. 中山大学附属第一医院广西医院护理部, 广西南宁 530000

分类号：R722.1;R473.72

出版年·卷·期（页码）：2026·54·第一期（1-8）

摘要：

目的：评估超声尖端定位和传统体表测量法与“金标准”X线在新生儿经外周置入中心静脉导管(PICC)置管后导管尖端的实际位置比较，评估其一致性程度，为提升新生儿PICC置管的精准性和安全性提供实证依据。方法：采用回顾性自身对照研究设计方法，纳入2023年6月1日至2025年5月26日中山大学附属第一医院新生儿科收治的195例行PICC新生儿为研究对象。采用Wilcoxon符号秩检验比较2种测量方法与“金标准”X线测量结果之间的绝对误差；组内相关系数(ICC)和Bland-Altman分析以评估其一致性。结果：与“金标准”X线相比，传统体表测量法的均值差为1.438 cm，95% LoA：-1.414~4.291 cm，界外点比例为3.6%，ICC为0.94；超声尖端法的均值差为0.503 cm，95% LoA：-1.358~2.364 cm，界外点比例为4.1%，ICC为0.98。亚组分析显示，在体质量≥2.5 kg[均值差：(0.37±0.90) cm，95%LoA：-1.39~2.13 cm]、32周≤胎龄＜37周[均值差：(0.29±1.04) cm，95%LoA：-1.75~2.33 cm]以及置管部位为下肢[均值差：(0.37±0.90) cm，95%LoA：-1.39~2.13 cm]的新生儿超声尖端定位置管长度与根据“金标准”X线结果调整后置管长度的均值差最小。结论：超声尖端定位在新生儿PICC置管中较传统体表测量法具有更优的准确性和一致性，尤其适用于体质量≥2.5 kg、32 w≤胎龄＜37 w、下肢静脉置管路径的新生儿群体。推荐将超声尖端定位技术作为新生儿PICC置管的首选定位方法，以提升置管操作的精准性与安全性。

Objective: To evaluate the consistency between ultrasound tip localization, traditional body surface measurement, and the “gold standard” X-ray in determining the actual tip position of peripherally inserted central catheters(PICC) in neonates after catheterization, and to provide empirical evidence for improving the accuracy and safety of neonatal PICC placement. Methods: A retrospective self-control study design was adopted, and 195 neonates who underwent PICC placement in the Department of Neonatology at the First Affiliated Hospital of Sun Yat-sen University from June 1 2023 to May 26 2025 were enrolled as research subjects. The absolute errors between the two measurement methods and the“gold standard” X-ray results were compared using the Wilcoxon signed-rank test; consistency was evaluated using the intraclass correlation coefficient(ICC) and Bland-Altman analysis. Results: Compared with the “gold standard” X-ray, the mean difference of traditional body surface measurement was 1.438 cm, 95% limits of agreement(LoA) -1.414- 4.291 cm, an outlier proportion of 3.6%, and an ICC of 0.94. For ultrasound tip localization, the mean difference was 0.503 cm, 95% LoA -1.358 - 2.364 cm, an outlier proportion of 4.1% and an ICC of 0.98. Subgroup analysis showed that the smallest mean difference between the catheter length determined by ultrasound tip localization and the adjusted catheter length based on the “gold standard” X-ray results was observed in neonates with body weight ≥2.5 kg[mean difference was(0.37±0.90) cm, 95% LoA -1.39 -2.13 cm], gestational age of 32-37 weeks[mean difference was(0.29±1.04) cm, 95% LoA -1.75 -2.33 cm] and those receiving catheterization via lower extremity veins[mean difference was(0.37±0.90) cm, 95% LoA -1.39- 2.13 cm]. Conclusion: Ultrasound tip localization has superior accuracy and consistency compared with traditional body surface measurement in neonatal PICC placement, and is particularly suitable for neonates with body weight ≥2.5 kg, gestational age of 32 -37 weeks and those undergoing lower extremity venous catheterization. It is recommended that ultrasound-guided tip positioning technology be used as the preferred method for neonatal PICC placement to improve the accuracy and safety of catheterization procedures.

参考文献：

[1] 张雨虹,邱艳茹,万永慧.PICC置管后首次换药时间的系统综述和Meta分析[J].现代医学,2024,52(4):618-627.
[2] 胡晓静,张玉侠,曹云,等.新生儿经上、下肢静脉置入中心静脉导管并发症比较——115例病例分析[J].中华围产医学杂志,2012(6):372-374.
[3] LING Q,CHEN H,TANG M,et al.Accuracy and safety study of intracavitary electrocardiographic guidance for peripherally inserted central catheter placement in neonates[J].J Perinat Neonatal Nurs,2019,33(1):89-95.
[4] DOYLE S C,BERGIN N M,YOUNG R,et al.Diagnostic accuracy of ultrasound for localising peripherally inserted central catheter tips in infants in the neonatal intensive care unit:a systematic review and meta-analysis[J].Pediatr Radiol,2022,52(12):2421-2430.
[5] SHARMA D,FARAHBAKHSH N,AHMAD TABATABAII S.Role of ultrasound for central catheter tip localization in neonates:a review of the current evidence[J].J Matern Fetal Neonatal Med,2019,32(14):2429-2437.
[6] 胡艳玲,唐孟言,李小文,等.新生儿PICC导管异位影响因素及预防措施的研究进展[J].护理学杂志,2020,35(22):105-108.
[7] 陈少波,彭嘉恒,杨春晖,等.新生儿水肿的高危因素及临床意义[J].中国实用医刊,2015(19):46-48.
[8] VILENSKY J A,SUÁREZ-QUIAN C A.Newborn anatomy[J].Clin Anat,2022,35(1):15-18.
[9] 王笑,徐艳,王军.极低、超低出生体重儿存活情况及住院并发症分析[J].现代医学,2020,48(1):82-87.
[10] D'ANDREA V,PRONTERA G,COTA F,et al.Real-time ultrasound tip location reduces malposition and radiation exposure during epicutaneo-caval catheter placement in neonates[J].Am J Perinatol,2024,41(S1):e1183-e1189.
[11] 陈晓春,陈琼,童燕芬,等.新生儿PICC尖端异位与自发矫正情况分析[J].中华护理杂志,2019,54(4):558-561.
[12] FIRSZT O,MALANKA M,GRABOWSKA A,et al.Standardized ultrasound protocol for peripherally inserted central catheters in neonates:a retrospective,X-ray controlled observational study[J].Children,2024,11(10):1204.
[13] GRASSO F,CAPASSO A,PACELLA D,et al.Ultrasound guided catheter tip location in neonates:a prospective cohort study[J].J Pediatr,2022,244:86-91.e2.
[14] MOTZ P,VON SAINT ANDRE VON ARNIM A,IYER R S,et al.Point-of-care ultrasound for peripherally inserted central catheter monitoring:a pilot study[J].J Perinat Med,2019,47(9):991-996.
[15] THAKUR A,KUMAR V,MODI M,et al.Use of point of care ultrasound for confirming central line tip position in neonates[J].Indian Pediatr,2020,57(9):805-807.
[16] KLEIDON T M,SCHULTS J A,ROYLE R H,et al.First-attempt success in ultrasound-guided vs standard peripheral intravenous catheter insertion:the EPIC superiority randomized clinical trial[J].JAMA Pediatr,2025,179(3):255-263.
[17] BONETT D G.Sample size requirements for estimating intraclass correlations with desired precision[J].Stat Med,2002,21(9):1331-1335.
[18] 陈琼,李颖馨,胡艳玲,等.新生儿经外周置入中心静脉导管操作及管理指南(2021)[J].中国当代儿科杂志,2021,23(3):201-212.
[19] Working Group of Clinical Practice Guideling on Infusion Therapy in Children,Nursing Group of Pediatric Branch of Chinese Medical Association,Center for Clinical Practice Guideline Development and Evaluation at Children's Hospital of Fudan University.儿童静脉输液治疗临床实践循证指南[J].中国循证儿科杂志,2021,16(1):1-42.
[20] 任晓玲,陈亚娟,刘敬,等.新生儿经外周置入中心静脉导管尖端位置超声定位技术的改进[J].中华实用儿科临床杂志,2021,36(24):1896-1899.
[21] 刘学秀,吴利平,陶晓军,等.早产儿PICC尖端超声定位与胸片定位效果比较[J].护理学杂志,2022,37(3):42-44.
[22] 鲍晓倩,范燕芳,陈婉婷,等.超声导管尖端定位在早产儿PICC置管中的应用[J].医学理论与实践,2025,38(7):1224-1226.
[23] 陈秀文,周乐山,谭彦娟,等.基于ACE Star循证模式选择新生儿经外周静脉穿刺的中心静脉导管置管部位[J].中南大学学报(医学版),2020,45(9):1082-1088.
[24] 付贞艳,权明桃,陈开永,等.新生儿不同静脉置入PICC效果的Meta分析[J].护士进修杂志,2020,35(3):218-225.
[25] 张小田,周凤英.超声导管尖端定位技术在早产儿PICC置管中的应用价值研究[J].中国超声医学杂志,2018,34(1):40-43.
[26] 谢晨鹏,舒琳,郭曼洁,等.新生儿经外周静脉置入中心静脉导管超声引导置管及尖端定位的最佳证据总结[J].中华现代护理杂志,2025,31(17):2262-2269.
[27] LIU X,TAO X,XU Y,et al.Comparison of bedside ultrasonography and bedside chest radiography in neonatal peripherally inserted central catheters:a before and after self-control study[J].Front Pediatr,2022,10:976826.

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