摘要
目的探讨手臂和呼吸运动对上臂完全植入式输液港(TIAP)导管尖端位置的影响。方法DSA下超声导引穿刺上臂静脉植入TIAP。术中、术后分别将患者手臂置于不同位置,深吸气下透视确认导管尖端位置,测量X线胸片上导管尖端至上腔静脉与右心房连接处(CAJ)距离。通过不同手臂运动和呼吸状态下导管尖端位置与固定解剖学标志间长度差判断导管尖端位置是否移动。结果83例恶性肿瘤患者成功植入上臂TIAP。76例(91.6%)手臂由外展90°转为内收位时导管尖端移位至足侧,移位长度(17.01±10.59)mm;60例(72.3%)由外展90°转为上举位时导管尖端移位至头侧,移位长度(13.47±11.49)mm;83例(100%)由外展位转为最大内收位时导管尖端均移位至足侧,移位长度(40.41±18.73)mm。外展位深吸气状态下74例(89.2%)导管尖端移位至头侧,移位长度(17.08±12.74)mm;内收位深吸气状态下79例(95.2%)导管尖端移位至头侧,移位长度(19.41±11.82)mm。配对t检验表明,手臂由外展90°转为内收位时导管尖端有向足侧移位趋势,外展90°转为上举位时有向头侧移位趋势,深吸气时有向头侧移位倾向,差异有统计学意义(均P<0.01)。导管尖端移位程度与性别、年龄、身高、体质量/体质量指数(BMI)间差异无统计学意义(均P>0.05)。结论不同手臂运动和呼吸状态下,上臂植入TIAP导管尖端位置是动态可变的。手臂由外展转向内收时,导管尖端易向足侧移位,而深吸气或手臂上举位时,导管尖端易向头侧移位。手臂由外展位转为最大内收位时,导管尖端均向足侧移位。
Objective To evaluate the influence of arm and breathing movements on the catheter tip position of totally implantable access port(TIAP)implanted via upper arm approach.Methods Under DSA imaging guidance,ultrasound-guided puncture of the upper arm vein with subsequent TIAP implantation was performed.During and after the operation,the patient’s arms were placed in different positions and the position of the catheter tip under deep inspiration was determined.The distance between the catheter tip and superior vena cava-right atrium joint(CAJ)was measured on chest X-ray film.The differences in the length between the catheter tip and the fixed anatomic mark under different arm movement and breathing status were used to judge whether the catheter tip position was moved or not.Results Successful implantation of TIAP was accomplished in 83 patients with malignancy.In 76 patients(91.6%),when the arm moved from 90°abduction position to adduction position,the catheter tip shifted to the foot side,with an average displacement length of(17.01±10.59)mm.In 60 patients(72.3%),when the arm moved from 90°abduction position to lift-up position,the catheter tip shifted to the head side,with an average displacement length of(13.47±11.49)mm.In 83 patients(100%),when the arm moved from 90°abduction position to maximum adduction position,the catheter tip shifted to the foot side,with an average displacement length of(40.41±18.73)mm.In deep inspiration status with arm abduction position,the catheter tip shifted to the head side in 74 patients(89.2%)and the average displacement length was(17.08±12.74)mm.In deep inspiration status with arm adduction position,the catheter tip shifted to the head side in 79 patients(95.2%)and the average displacement length was(19.41±11.82)mm.Paired t-test indicated that when the arm position changed from 90°abduction position to adduction position the tip of the catheter had a tendency to shift toward the foot side,contrarily,when the arm position changed from 90°abduction position to lift-up po
作者
仇晓霞
金光鑫
郭艳
张学彬
QIU Xiaoxia;JIN Guangxin;GUO Yan;ZHANG Xuebin(Department of Oncology,Affiliated Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China)
出处
《介入放射学杂志》
CSCD
北大核心
2022年第12期1155-1159,共5页
Journal of Interventional Radiology
基金
上海交通大学医学院附属仁济医院教师企业实践专项课题项目(hlzjsj202005)。
关键词
完全植入式输液港
尖端位置
手臂运动
呼吸
totally implantable access port
catheter tip position
arm movement
breathing
