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[Chest最新论文]:超声引导下置入中心静脉导管后是否需要常规进行胸片检查?
2018年07月22日 时讯速递, 进展交流 暂无评论

Is Routine Chest X-Ray After Ultrasound-Guided Central Venous Catheter Insertion Choosing Wisely?: A Population-Based Retrospective Study of 6,875 Patients

Jason Chui, Rasha Saeed, Luke Jakobowski, et al

Chest 2018; 154: 148-156

Background 背景

A routine chest radiograph (CXR) is recommended as a screening test after central venous catheter (CVC) insertion. The goal of this study was to assess the value of a routine postprocedural CXR in the era of ultrasound-guided CVC insertion.

置入中心静脉导管(CVC)后推荐常规进行胸片(CXR)作为筛查。本研究的目的在于评价超声引导下置入CVC后常规CXR检查的价值。

Methods 方法

This population-based retrospective cohort study was performed to review the records of all adult patients who had a CVC inserted in the operating room in a tertiary institution between July 1, 2008, and December 31, 2015. We determined the incidence of pneumothorax and catheter misplacement after ultrasound-guided CVC insertion. A logistic regression analysis was performed to examine the potential risk factors associated with these complications, and a cost analysis was conducted to evaluate the economic impact.

在这项基于人群的回顾性队列研究中,我们回顾了2008年7月1日至2015年12月31日期间一所三级医院手术室置入CVC的所有成年患者病例资料。我们计算了超声引导下置入CVC后气胸及导管位置错误的发生率。我们进行了logistic回归分析以确定与上述并发症有关的危险因素,同时进行费用分析以评估经济影响。

Results 结果

Of 18,274 patients who had a CVC inserted, 6,875 patients were included. The overall incidence of pneumothorax and catheter misplacement was 0.33% (95% CI, 0.22-0.5) (23 patients) and 1.91% (95% CI, 1.61-2.26) (131 patients), respectively. The site of catheterization was the major determinant of pneumothorax and catheter misplacement; left subclavian vein catheterization was the site at a higher risk for pneumothorax (OR, 6.69 [95% CI, 2.45-18.28]; P < .001), and catheterization sites other than the right internal jugular vein were at a higher risk for catheter misplacement. Expenditures on routine postprocedural CXR were US $105,000 to $183,000 per year at our institution.

总共18274名置入CVC的患者中,我们纳入了6875名患者。气胸和导管位置错误的总体发生率分别为0.33% (95% CI, 0.22-0.5)(23名患者)和1.91% (95% CI, 1.61-2.26)(131名患者)。置管位置是气胸和导管位置错误的决定因素;左侧锁骨下静脉置管气胸发生率最高(OR, 6.69 [95% CI, 2.45-18.28]; P < .001),右侧颈内静脉以外的其他部位置管时导管位置错误的风险最高。我们医院每年操作后常规CXR的费用为US $105,000 至 $183,000 之间。

Conclusions 结论

This study found that pneumothorax and catheter misplacement after ultrasound-guided CVC insertion were rare, and the costs of a postprocedural CXR were exceedingly high. We concluded that a routine postprocedural CXR is unnecessary and not a wise choice in our setting.

本研究发现,超声引导下置入CVC后气胸和导管位置错误很罕见,操作后CXR的费用极高。我们认为,在这种情况下,操作后常规CXR并无必要,也不是明智的选择。

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