【摘要】 目的　探讨新生儿应用外周穿刺中心静脉导管 (PICC)对血液动力学的影响。方法　 2 0 0 0年 12月至2 0 0 2年 10月广州市第二医院采用HP - 85 0 0型超声诊断仪检测 4 6例应用PICC新生儿血管内径 (D)、血流频谱曲线 ,收缩期、舒张期及平均血流速度 (Vs、Vd、Vmean)。结果　置管血管管壁显示清晰 ,导管呈“ =”样强回声 ,未见局限性异常回声 ,血流频谱呈双相三峰型。Vs(14 10± 4 86 )cm/s、Vd(9 6 4± 2 87)cm/s、Vmean(8 72± 2 95 )cm/s,较对侧减慢 (P <0 0 1) ;D(0 2 4± 0 0 2 )cm ,较对侧增大 (P <0 0 1)。 16例患儿拔除导管后Vs(2 4 10± 6 19)cm/s、Vd(16 4 3± 5 5 3)cm/s、Vmean(12 95± 4 33)cm/s,较置管时增快 (P <0 0 1) ;D(0 18± 0 0 1)cm ,较置管时缩小(P <0 0 1) ;拔管后双侧血管比较各项指标无显著差异 (P >0 0 5 )。置管时间、体重、穿刺血管对血流速度、血管内径无明显影响 ;导管堵塞时Vd减慢 (P <0 0 5 )。结论　新生儿应用PICC致局部血流动力学改变 ,导管拔除后可恢复正常 ;彩色多普勒有助于判断与血栓形成有关的导管堵塞。更多还原

【Abstract】 Objective To explore the influence of peripherally inserted central catheterization(PICC) on the hemodynamics in newborn infants.Methods We used a HP-8500 style ultrasonography machine to examine 43 newborn infants with PICC.We detected the inner diameter of vessel(D),the blood flow frequency spectrum curve,the systolic velocity of blood flow(Vs),the diastolic velocity of blood flow(Vd),and the mean velocity of blood flow(Vmean).Results The visualization of the wall of catheter inserted vessels was clear.The echo of the catheter is a "=" shape strong echo,but localizable abnormal echo was not found.The blood flow frequency spectrum curve was diphasic tripeak mode.Vs(14.17±4.82)cm/s,Vd(9.64±2.87)cm/s,Vmean(8.72±2.95)cm/s,which were decreased compared with the other side vessel.D(0 24±0 02)cm,which was enlarged compared with the other side(P<0 01).16 cases were detected after removing the catheters,Vs(24.10±6.19)cm/s,Vd(16.43±5.53)cm/s,Vmeam(12.95±4.33)cm/s,which were faster than when catheters were inserted(P<0 01);D(0.18±0.01)cm,which was smaller than when catheters were inserted(P<0 01).After removing the catheters,there was no obvious difference between the indices found on both sides(P>0 05).There was no obvious influence of the time,the weight and the vessles we punctured on the velocity of blood flow and the inner diameter of vessel. The Vd was slower when the catheters were occluded (P<0 05).Conclusion Using PICC in newborn infants can lead to some changes in hemodynamics.All parameters normalize after removing the catheters.Color doppler ultrasonography can help us to detect catheter occlusion that leads to the incidence of thrombosis.更多还原