新生儿经外周静脉穿刺中心静脉置管相关胸腔积液临床诊治分析
Clinical diagnosis and treatment of pleural effusion associated with peripheral inserted central catheters in neonates
陈岩 1黑明燕 1刘仕祺 1钟学红 1窦文艳 1齐宇洁1
作者信息
- 1. 国家儿童医学中心新生儿中心/首都医科大学附属北京儿童医院新生儿中心,北京 100045
- 折叠
摘要
目的 探讨新生儿经外周静脉穿刺中心静脉置管(peripherally inserted central catheters,PICC)相关胸腔积液的临床特点及预后.方法 回顾性分析北京儿童医院新生儿中心2016年6月至2023年6月明确诊断为PICC相关的胸腔积液新生儿的临床资料,总结其临床特点、治疗及预后情况.结果 共纳入29例患儿,其中早产儿24例(82.8％).27例(93.1％)以突发呼吸困难起病,不伴发热、反应差等全身感染表现;2例为隐匿起病.28例(96.6％)患儿经上肢或头部静脉放置PICC,25例导管尖端位置位于上腔静脉内,3例位于C7～T2;1例经右股静脉放置PICC,导管尖端位置位于T8下缘;18例(62.1％)患儿发生导管尖端异位;胸部X线片发现胸腔积液后,均及时拔除PICC,19例(65.5％)患儿行胸腔穿刺,19例(65.5％)患儿需调整呼吸支持方式或上调呼吸机参数.所有患儿均治愈出院,预后良好.结论 留置PICC的患儿如出现呼吸困难或加重,需要鉴别是否出现胸腔积液并发症,确定存在PICC相关胸腔积液后应及时拔除PICC,必要时胸腔穿刺,多预后良好.
Abstract
Objective To study the clinical features and prognosis of pleural effusion associated with peripherally inserted central catheter(PICC)in neonates.Methods From June 2016 to June 2023,neonates diagnosed with pleural effusion associated with PICC in the neonatal center of our hospital were retrospectively analyzed,and their clinical characteristics,treatment and prognosis were summarized.Results A total of 29 neonates were enrolled,including 24(82.8％)preterm infants.27 cases(93.1％)presented with sudden onset of dyspnea without systemic infections such as fever and poor response.2 cases had insidious onset.In 28 cases(96.6％),PICC was placed via the upper limb or head/neck vein.The catheter tip was located in the superior vena cava in 25 cases and C7-T2 vertebrae in 3 cases.The PICC was placed through the right femoral vein in 1 case and the tip of the catheter was located at the lower edge of T8.18 cases(62.1％)had PICC dislodgement.After chest X-ray indicated pleural effusion,all catheters were removed in time.19 cases(65.5％)received thoracentesis.19 cases(65.5％)needed respiratory support adjustment.All neonates were cured and discharged with good prognosis.Conclusions If neonates with PICC have dyspnea or deterioration of disease,it is necessary to rule out pleural effusion.The catheter should be removed in time if PICC associated pleural effusion is confirmed and thoracentesis should be performed if necessary.The prognosis is generally favorable.
关键词
经外周穿刺中心静脉置管/胸腔积液/新生儿/临床特点Key words
Peripherally inserted central catheters/Pleural effusion/Newborn/Clinical characteristics引用本文复制引用
出版年
2024
NETL
NSTL
万方数据