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Article(id=1322929517957882330, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929431592972373, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.15.005, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1755705600000, receivedDateStr=2025-08-21, revisedDate=1777392000000, revisedDateStr=2026-04-29, acceptedDate=null, acceptedDateStr=null, onlineDate=1793340575923, onlineDateStr=2026-10-30, pubDate=1786291200000, pubDateStr=2026-08-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793340575923, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793340575923, creator=13701087609, updateTime=1793340575923, updator=13701087609, issue=Issue{id=1322929431592972373, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='15', pageStart='2577', pageEnd='2768', issueExtLink='null', onlineDate='null', pubDate='1786291200000', pubDateStr='2026-08-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793340555332, creator='13701087609', updateTime=1793343107287, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322940135335145743, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929431592972373, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322940135335145744, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929431592972373, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2616, endPage=2622, ext={EN=ArticleExt(id=1322929518775771614, articleId=1322929517957882330, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Risk identification of secondary displacement of PICC catheters in very low birth weight infants based on weight growth trajectories, columnId=1220689484526572183, journalTitle=Chinese Nursing Research, columnName=Original Articles, runingTitle=null, highlight=null, articleAbstract=
Objective

To identify growth trajectory of weight by using latent class growth modeling,and to analyze the risk of secondary PICC catheter displacement in very low birth weight(VLBW) infants with different trajectories.

Methods

By a convenience sampling method,very low birth weight infants who underwent PICC placement admitted to Shanxi Bethune Hospital from January 2022 to December 2024 were selected as the survey subjects.Latent class growth modeling was used to identify the weight growth trajectory of the infants after catheterization for 4 weeks.Multivariate Cox regression analysis was used to identify the risk factors for secondary catheter displacement in the infants.The survival curves were drawn to compare the occurrence of secondary catheter displacement in infants with different weight growth trajectories.

Results

A total of 212 very low birth weight infants were included.According to their weight growth trajectory after catheterization,they were divided into three types:decline-then-rise type(38.2%),rise-then-decline type(17.5%),and relatively stable type(44.3%).Multivariate Cox regression analysis results showed that decline-then-rise type[HR=4.290,95%CI (1.853,9.923)],and rise-then-decline type[HR=3.399,95%CI(1.352,8.535)]were risk factors for secondary catheter displacement in very low birth weight infants.The survival curve results showed that with the relatively stable type as a reference,the risk of catheter displacement was higher in the decline-then-rise type(χ2=6.786,P=0.005) and rise-then-decline type(χ2=9.861,P<0.05).There was no statistically significant difference in terms of the risk of catheter displacement between the decline-then-rise type and the rise-then-decline type(χ2=0.507,P=0.476).

Conclusions

The weight growth trajectory of very low birth weight infants after catheterization included three types:decline-then-rise type,rise-then-decline type,and relatively stable type.Decline-then-rise type and rise-then-decline type are risk factors for secondary catheter displacement in very low birth weight infants.Risk stratification of PICC catheter secondary displacement based on different weight growth trajectories could provide a basis for early intervention by medical staff.

, authors=Yu GUO, Li WANG, Yiwei LI, Meibian GU, Jiaying GUO, authorsList=Yu GUO, Li WANG, Yiwei LI, Meibian GU, Jiaying GUO, authorCompany=null, correspAuthors=Li WANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322929524681351651, articleId=1322929517957882330, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=基于体重增长轨迹识别极低出生体重儿PICC导管继发性移位风险, columnId=1220689484681761433, journalTitle=护理研究, columnName=科研论著, runingTitle=null, highlight=null, articleAbstract=
目的

通过潜类别增长模型识别极低出生体重儿（VLBW）体重增长轨迹，并分析不同轨迹患儿经外周静脉穿刺置入中心静脉导管（PICC）继发性移位风险。

方法

采用便利抽样法，选取2022年1月—2024年12月于山西白求恩医院置入PICC的极低出生体重儿作为调查对象，采用潜类别增长模型识别极低出生体重儿置管后4周的体重增长轨迹，采用多因素Cox回归分析患儿导管继发性移位的危险因素，并绘制生存曲线比较不同体重增长轨迹患儿导管继发性移位的发生情况。

结果

共纳入212例极低出生体重儿，根据置管后患儿体重增长轨迹，将其分为先降后升型（38.2%）、先升后降型（17.5%）和相对稳定型（44.3%）。多因素Cox回归分析结果显示，先降后升型［HR=4.290，95%CI（1.853，9.923）］和先升后降型［HR=3.399，95%CI（1.352，8.535）］是极低出生体重儿导管继发性移位的危险因素。生存曲线结果显示，以相对稳定型为参考，先降后升型（χ2=6.786，P=0.005）和先升后降型（χ2=9.861，P<0.05）患儿导管移位发生风险更高，先降后升型与先升后降型患儿导管移位发生风险差异无统计学意义（χ2=0.507，P=0.476）。

结论

极低出生体重儿置管后体重增长轨迹可分为先降后升型、先升后降型和相对稳定型，先降后升型和先升后降型是极低出生体重儿导管继发性移位的危险因素，根据不同体重增长轨迹对PICC导管继发性移位进行危险分层，可为医护人员早期干预提供依据。

, authors=郭瑜, 王丽*, *, 李怡玮, 谷美便, 郭佳莹, authorsList=郭瑜, 王丽, 李怡玮, 谷美便, 郭佳莹, authorCompany=null, correspAuthors=王丽, authorNote=

郭瑜，主管护师，本科

, correspAuthorsNote=
王丽，E-mail：
WANG Li, E-mail:
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study(vascular echography evaluation in infants and neonates)[J].J Vasc Access,2024,25(4):1114-1120., articleTitle=Caliber of the deep veins of the arm in infants and neonates:the VEEIN study(vascular echography evaluation in infants and neonates), refAbstract=null), Reference(id=1322929544839176766, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929517957882330, doi=null, pmid=null, pmcid=null, year=2026, volume=40, issue=3, pageStart=479, pageEnd=483, url=null, language=null, rfNumber=29, rfOrder=28, authorNames=唐熙, 胡晓静, 吕天婵, journalName=护理研究, refType=null, unstructuredReference=唐熙,胡晓静,吕天婵,等.改良塞丁格微创技术在极低/超低出生体重儿PICC置管中的应用[J].护理研究,2026,40(3):479-483., articleTitle=改良塞丁格微创技术在极低/超低出生体重儿PICC置管中的应用, refAbstract=null), Reference(id=1322929544897897023, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929517957882330, doi=null, pmid=null, pmcid=null, year=2025, volume=6, issue=10, pageStart=1183, pageEnd=1188, url=null, language=null, rfNumber=30, rfOrder=29, authorNames=李平平, 李莹, 苏鑫, journalName=中华急危重症护理杂志, refType=null, unstructuredReference=李平平,李莹,苏鑫,等.PICC继发性异位管理方案构建及在极低出生体重儿中的应用[J].中华急危重症护理杂志,2025,6(10):1183-1188., articleTitle=PICC继发性异位管理方案构建及在极低出生体重儿中的应用, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322929525939642853, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929517957882330, xref=1, ext=[AuthorCompanyExt(id=1322929525952225766, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929517957882330, companyId=1322929525939642853, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Shanxi Bethune Hospital(Shanxi Academy of Medical Sciences), Third Hospital of Shanxi Medical University,Tongji Shanxi Hospital, Shanxi 030032 China), AuthorCompanyExt(id=1322929525956420072, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929517957882330, companyId=1322929525939642853, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1山西白求恩医院（山西医学科学院），山西医科大学第三医院，同济山西医院，山西 030032)])], figs=[ArticleFig(id=1322929533858488849, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929517957882330, language=EN, label=Figure 1, caption=Trajectory of weight growth rate in very low birth weight infants, figureFileSmall=8DCUvBn4e0h1UR5q09sVqQ==, figureFileBig=qF9pV0cnzfafISiOr6Tf9A==, tableContent=null), ArticleFig(id=1322929533942374930, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929517957882330, language=CN, label=图1, caption=极低出生体重儿体重增长率的变化轨迹, figureFileSmall=8DCUvBn4e0h1UR5q09sVqQ==, figureFileBig=qF9pV0cnzfafISiOr6Tf9A==, tableContent=null), ArticleFig(id=1322929534290502163, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929517957882330, language=EN, label=Figure 2, caption=Survival curve analysis of catheter displacement in infants with different weight trajectories, figureFileSmall=z9MDX6tGX6+QAKd8CQ05AA==, figureFileBig=y+1MiQDSQegzVbVeHVIDmw==, tableContent=null), ArticleFig(id=1322929534370193940, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929517957882330, language=CN, label=图2, caption=不同体重变化轨迹患儿导管移位生存曲线分析, figureFileSmall=z9MDX6tGX6+QAKd8CQ05AA==, figureFileBig=y+1MiQDSQegzVbVeHVIDmw==, tableContent=null), ArticleFig(id=1322929534437302805, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929517957882330, language=EN, label=Table 1, caption=

Fitting indices of latent class growth models for weight growth trajectories in very low birth weigh infants

, figureFileSmall=null, figureFileBig=null, tableContent=
模型AICBICaBICEntropyP类别概率（%）
LMRTBLRT
14 001.6904 028.5434 003.194
23 565.2703 608.9063 567.7130.8860.009<0.00161.8/38.2
33 520.0303 580.4483 523.4120.885<0.001<0.00138.2/17.5/44.3
43 505.7063 582.9073 510.0280.8660.119<0.00125.0/38.2/25.0/11.8
53 503.5703 597.5543 508.8320.7870.0030.10325.5/6.6/25.5/38.2/4.2
), ArticleFig(id=1322929534705738262, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929517957882330, language=CN, label=表1, caption=

极低出生体重儿体重增长变化轨迹的潜类别增长模型拟合指标

, figureFileSmall=null, figureFileBig=null, tableContent=
模型AICBICaBICEntropyP类别概率（%）
LMRTBLRT
14 001.6904 028.5434 003.194
23 565.2703 608.9063 567.7130.8860.009<0.00161.8/38.2
33 520.0303 580.4483 523.4120.885<0.001<0.00138.2/17.5/44.3
43 505.7063 582.9073 510.0280.8660.119<0.00125.0/38.2/25.0/11.8
53 503.5703 597.5543 508.8320.7870.0030.10325.5/6.6/25.5/38.2/4.2
), ArticleFig(id=1322929534798012951, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929517957882330, language=EN, label=Table 2, caption=

Comparison of general characteristics among infants with different weight growth trajectories（n=212）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目先降后升型（n=81）先升后降型（n=37）相对稳定型（n=94）统计值P
性别[例（%）] 男37（45.7）23（62.2）55（58.5）χ2=4.0180.134
女44（54.3）14（37.8）39（41.5）
出生胎龄（周）32.14±2.6832.19±2.5732.00±2.52F=0.0960.909
出生体重（g）1 212.0（1 084.5，1 324.5）1 120.0（1 019.5，1 257.5）1 167.5（1 020.3，1 305.3）H=2.2930.318
置管时日龄（d）3.0（1.0，5.5）4.0（2.0，5.0）4.0（2.0，6.0）H=5.7900.031
置管时体重（g）1 285.0（1 152.5，1 403.5）1 199.0（1 092.5，1 336.5）1 246.5（1 092.5，1 384.3）H=1.6070.448
肠外营养时间（d）16.0（11.5，20.0）16.0（12.5，21.0）17.0（12.8，21.0）H=3.0760.215
穿刺部位[例（%）]上肢43（53.1）15（40.5）46（48.9）χ2=1.6010.449
下肢38（46.9）22（59.5）48（51.1）
穿刺静脉[例（%）]贵要静脉60（74.1）29（78.4）80（85.1）χ2=3.3250.190
其他21（25.9）8（21.6）14（14.9）
总置管时间（d）19.0（14.5，23.0）19.0（15.5，24.0）20.5（16.0，24.3）H=4.2750.118
), ArticleFig(id=1322929534881899032, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929517957882330, language=CN, label=表2, caption=

不同体重增长轨迹患儿的一般资料比较（n=212）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目先降后升型（n=81）先升后降型（n=37）相对稳定型（n=94）统计值P
性别[例（%）] 男37（45.7）23（62.2）55（58.5）χ2=4.0180.134
女44（54.3）14（37.8）39（41.5）
出生胎龄（周）32.14±2.6832.19±2.5732.00±2.52F=0.0960.909
出生体重（g）1 212.0（1 084.5，1 324.5）1 120.0（1 019.5，1 257.5）1 167.5（1 020.3，1 305.3）H=2.2930.318
置管时日龄（d）3.0（1.0，5.5）4.0（2.0，5.0）4.0（2.0，6.0）H=5.7900.031
置管时体重（g）1 285.0（1 152.5，1 403.5）1 199.0（1 092.5，1 336.5）1 246.5（1 092.5，1 384.3）H=1.6070.448
肠外营养时间（d）16.0（11.5，20.0）16.0（12.5，21.0）17.0（12.8，21.0）H=3.0760.215
穿刺部位[例（%）]上肢43（53.1）15（40.5）46（48.9）χ2=1.6010.449
下肢38（46.9）22（59.5）48（51.1）
穿刺静脉[例（%）]贵要静脉60（74.1）29（78.4）80（85.1）χ2=3.3250.190
其他21（25.9）8（21.6）14（14.9）
总置管时间（d）19.0（14.5，23.0）19.0（15.5，24.0）20.5（16.0，24.3）H=4.2750.118
), ArticleFig(id=1322929534957396505, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929517957882330, language=EN, label=Table 3, caption=

Univariate analysis results of factors influencing secondary displacement of PICC catheters in very low birth weight infants（n=212）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类发生继发性移位（n=38）未发生继发性移位（n=174）统计值P
性别[例（%）]男23（60.5）92（52.9）χ2=0.7360.391
女15（39.5）82（47.1）
出生胎龄（周）31.74±2.6532.16±2.57t=0.9170.360
出生体重（g）1 130.5（1 050.5，1 234.3）1 189.5（1 024.3，1 318.3）Z=1.2540.210
置管时日龄（d）4.0（2.0，5.3）3.5（2.0，6.0）Z=0.9290.353
置管时体重（g）1 185.0（1 103.8，1 284.3）1 268.5（1 103.3，1 397.3）Z=2.0370.042
肠外营养时间（d）17.0（11.8，20.3）17.0（12.0，21.0）Z=0.1430.886
穿刺部位[例（%）]上肢13（34.2）91（52.3）χ2=4.0830.043
下肢25（65.8）83（47.7）
穿刺静脉[例（%）]贵要静脉29（76.3）140（80.5）χ2=0.3310.565
其他9（23.7）34（19.5）
总置管时间（d）20.0（14.8，23.3）20.0（16.0，24.0）Z=0.2760.782
体重增长轨迹[例（%）]先降后升型19（50.0）62（35.6）
先升后降型11（28.9）26（14.9）χ2=10.8530.004
相对稳定型8（21.1）86（49.4）
), ArticleFig(id=1322929535146140186, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929517957882330, language=CN, label=表3, caption=

极低出生体重儿PICC导管继发性移位影响因素的单因素分析结果（n=212）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类发生继发性移位（n=38）未发生继发性移位（n=174）统计值P
性别[例（%）]男23（60.5）92（52.9）χ2=0.7360.391
女15（39.5）82（47.1）
出生胎龄（周）31.74±2.6532.16±2.57t=0.9170.360
出生体重（g）1 130.5（1 050.5，1 234.3）1 189.5（1 024.3，1 318.3）Z=1.2540.210
置管时日龄（d）4.0（2.0，5.3）3.5（2.0，6.0）Z=0.9290.353
置管时体重（g）1 185.0（1 103.8，1 284.3）1 268.5（1 103.3，1 397.3）Z=2.0370.042
肠外营养时间（d）17.0（11.8，20.3）17.0（12.0，21.0）Z=0.1430.886
穿刺部位[例（%）]上肢13（34.2）91（52.3）χ2=4.0830.043
下肢25（65.8）83（47.7）
穿刺静脉[例（%）]贵要静脉29（76.3）140（80.5）χ2=0.3310.565
其他9（23.7）34（19.5）
总置管时间（d）20.0（14.8，23.3）20.0（16.0，24.0）Z=0.2760.782
体重增长轨迹[例（%）]先降后升型19（50.0）62（35.6）
先升后降型11（28.9）26（14.9）χ2=10.8530.004
相对稳定型8（21.1）86（49.4）
), ArticleFig(id=1322929535221637659, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929517957882330, language=EN, label=Table 4, caption=

Variable assignment status

, figureFileSmall=null, figureFileBig=null, tableContent=
项目赋值方式
置管时体重原值输入
穿刺部位下肢=0，上肢=1
体重增长轨迹相对稳定型=（0，0），先降后升型=（0，1），先升后降型=（1，0）
导管继发性移位未发生=0，发生=1
), ArticleFig(id=1322929535292940828, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929517957882330, language=CN, label=表4, caption=

变量赋值情况

, figureFileSmall=null, figureFileBig=null, tableContent=
项目赋值方式
置管时体重原值输入
穿刺部位下肢=0，上肢=1
体重增长轨迹相对稳定型=（0，0），先降后升型=（0，1），先升后降型=（1，0）
导管继发性移位未发生=0，发生=1
), ArticleFig(id=1322929535368438301, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929517957882330, language=EN, label=Table 5, caption=

Multivariate analysis results of factors influencing secondary displacement of PICC catheters in very low birth weight infants

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类回归系数标准误Wald χ2值PHR值95%CI
置管时体重-0.1020.2370.1850.0660.903[0.567，1.437]
穿刺部位-0.7820.3455.1410.0230.457[0.233，0.899]
体重增长轨迹先降后升型1.4560.42811.5560.0014.290[1.853，9.923]
先升后降型1.2230.4706.7750.0093.399[1.352，8.535]
), ArticleFig(id=1322929535460712990, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929517957882330, language=CN, label=表5, caption=

极低出生体重儿PICC导管继发性移位影响因素的多因素分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类回归系数标准误Wald χ2值PHR值95%CI
置管时体重-0.1020.2370.1850.0660.903[0.567，1.437]
穿刺部位-0.7820.3455.1410.0230.457[0.233，0.899]
体重增长轨迹先降后升型1.4560.42811.5560.0014.290[1.853，9.923]
先升后降型1.2230.4706.7750.0093.399[1.352，8.535]
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基于体重增长轨迹识别极低出生体重儿PICC导管继发性移位风险
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郭瑜 , 王丽 *, * , 李怡玮 , 谷美便 , 郭佳莹
护理研究 | 科研论著 2026,40(15): 2616-2622
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护理研究 |科研论著 2026 , 40 (15) : 2616 -2622
基于体重增长轨迹识别极低出生体重儿PICC导管继发性移位风险
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郭瑜, 王丽*, * , 李怡玮, 谷美便, 郭佳莹
作者信息
  • 1山西白求恩医院（山西医学科学院），山西医科大学第三医院，同济山西医院，山西 030032
通讯作者:
王丽，E-mail：
WANG Li, E-mail:
作者简介:

郭瑜，主管护师，本科

Risk identification of secondary displacement of PICC catheters in very low birth weight infants based on weight growth trajectories
Yu GUO, Li WANG , Yiwei LI, Meibian GU, Jiaying GUO
Affiliations
  • 1Shanxi Bethune Hospital(Shanxi Academy of Medical Sciences), Third Hospital of Shanxi Medical University,Tongji Shanxi Hospital, Shanxi 030032 China
出版时间: 2026-08-10 doi: 10.12102/j.issn.1009-6493.2026.15.005
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摘要
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目的

通过潜类别增长模型识别极低出生体重儿（VLBW）体重增长轨迹，并分析不同轨迹患儿经外周静脉穿刺置入中心静脉导管（PICC）继发性移位风险。

方法

采用便利抽样法，选取2022年1月—2024年12月于山西白求恩医院置入PICC的极低出生体重儿作为调查对象，采用潜类别增长模型识别极低出生体重儿置管后4周的体重增长轨迹，采用多因素Cox回归分析患儿导管继发性移位的危险因素，并绘制生存曲线比较不同体重增长轨迹患儿导管继发性移位的发生情况。

结果

共纳入212例极低出生体重儿，根据置管后患儿体重增长轨迹，将其分为先降后升型（38.2%）、先升后降型（17.5%）和相对稳定型（44.3%）。多因素Cox回归分析结果显示，先降后升型［HR=4.290，95%CI（1.853，9.923）］和先升后降型［HR=3.399，95%CI（1.352，8.535）］是极低出生体重儿导管继发性移位的危险因素。生存曲线结果显示，以相对稳定型为参考，先降后升型（χ2=6.786，P=0.005）和先升后降型（χ2=9.861，P<0.05）患儿导管移位发生风险更高，先降后升型与先升后降型患儿导管移位发生风险差异无统计学意义（χ2=0.507，P=0.476）。

结论

极低出生体重儿置管后体重增长轨迹可分为先降后升型、先升后降型和相对稳定型，先降后升型和先升后降型是极低出生体重儿导管继发性移位的危险因素，根据不同体重增长轨迹对PICC导管继发性移位进行危险分层，可为医护人员早期干预提供依据。

极低出生体重儿  /  经外周置入中心静脉导管  /  体重增长  /  继发性移位  /  影响因素  /  潜类别增长模型
Objective

To identify growth trajectory of weight by using latent class growth modeling,and to analyze the risk of secondary PICC catheter displacement in very low birth weight(VLBW) infants with different trajectories.

Methods

By a convenience sampling method,very low birth weight infants who underwent PICC placement admitted to Shanxi Bethune Hospital from January 2022 to December 2024 were selected as the survey subjects.Latent class growth modeling was used to identify the weight growth trajectory of the infants after catheterization for 4 weeks.Multivariate Cox regression analysis was used to identify the risk factors for secondary catheter displacement in the infants.The survival curves were drawn to compare the occurrence of secondary catheter displacement in infants with different weight growth trajectories.

Results

A total of 212 very low birth weight infants were included.According to their weight growth trajectory after catheterization,they were divided into three types:decline-then-rise type(38.2%),rise-then-decline type(17.5%),and relatively stable type(44.3%).Multivariate Cox regression analysis results showed that decline-then-rise type[HR=4.290,95%CI (1.853,9.923)],and rise-then-decline type[HR=3.399,95%CI(1.352,8.535)]were risk factors for secondary catheter displacement in very low birth weight infants.The survival curve results showed that with the relatively stable type as a reference,the risk of catheter displacement was higher in the decline-then-rise type(χ2=6.786,P=0.005) and rise-then-decline type(χ2=9.861,P<0.05).There was no statistically significant difference in terms of the risk of catheter displacement between the decline-then-rise type and the rise-then-decline type(χ2=0.507,P=0.476).

Conclusions

The weight growth trajectory of very low birth weight infants after catheterization included three types:decline-then-rise type,rise-then-decline type,and relatively stable type.Decline-then-rise type and rise-then-decline type are risk factors for secondary catheter displacement in very low birth weight infants.Risk stratification of PICC catheter secondary displacement based on different weight growth trajectories could provide a basis for early intervention by medical staff.

very low birth weight infants,VLBM  /  peripherally inserted central catheter,PICC  /  weight growth  /  secondary displacement  /  influencing factors  /  latent class growth modeling,LCGM
郭瑜, 王丽, 李怡玮, 谷美便, 郭佳莹. 基于体重增长轨迹识别极低出生体重儿PICC导管继发性移位风险. 护理研究, 2026 , 40 (15) : 2616 -2622 . DOI: 10.12102/j.issn.1009-6493.2026.15.005
Yu GUO, Li WANG, Yiwei LI, Meibian GU, Jiaying GUO. Risk identification of secondary displacement of PICC catheters in very low birth weight infants based on weight growth trajectories[J]. Chinese Nursing Research, 2026 , 40 (15) : 2616 -2622 . DOI: 10.12102/j.issn.1009-6493.2026.15.005
正文
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极低出生体重儿（very low birth weight，VLBW）指出生体重低于1 500 g的早产儿，由于极低出生体重儿胃肠道发育不成熟，需要较长时间进行静脉营养[1]。经外周置入中心静脉导管（peripherally inserted central catheter，PICC）是新生儿危重症护理的重要静脉通路，可减少反复穿刺损伤、降低药物外渗风险，在极低出生体重儿长期肠外营养支持中发挥重要作用[2-3]。然而，在PICC置管期间，新生儿体重快速增长容易引起管尖端位置发生偏移。继发性移位是指PICC初始定位良好，但在留置过程中发生移位的情况[4]。PICC导管继发性移位可导致胸腔积液、心脏压塞、血栓形成等严重并发症，严重威胁患儿健康安全[5]。更重要的是，继发性移位常呈隐匿性进展，需X线确定导管尖端位置，而多次X线摄片可增加射线暴露，对患儿生长发育造成不利影响[6]。因此，早期识别PICC导管继发性移位风险，对保证极低出生体重儿静脉通路安全、减少射线暴露具有重要意义。研究表明，新生儿体重与导管尖端位置存在明显相关关系，极低出生体重儿体重每增加100 g，PICC导管尖端位置远离心脏0.33个椎体[7]。但是极低出生体重儿体重呈非线性增长，这种增长轨迹可牵拉躯体解剖结构，使原本精准定位于腔静脉的导管尖端随身体生长发育发生相对位移[8]。目前研究多采用体重平均增长率预测导管移位风险。然而，极低出生体重儿发育受多种因素影响，遗传、营养状态、疾病因素均可导致体重增长出现个体差异[9-10]。因此，本研究通过潜类别增长模型（latent class growth model，LCGM）识别极低出生体重儿体重增长的不同轨迹，并据此分析PICC导管继发性移位风险，以期为临床护理提供参考。
1　资料与方法
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1.1　调查对象
采用前瞻性纵向调查设计，使用便利抽样法选取2022年1月—2024年12月山西白求恩医院收治的极低出生体重儿作为调查对象。纳入标准：1）出生体重<1 500 g的早产儿；2）PICC导管首次置管为出生后1周内；3）首次胸腹部X线片定位PICC导管尖端位于理想位置；4）PICC导管留置时间2周及以上；5）患儿监护人签署知情同意书。排除标准：1）胸廓畸形、严重水肿患儿；2）X片中导管尖端位置模糊不清；3）导管置入前有严重感染者。脱落标准：1）导管置入后出现严重并发症，如心包积液、胸腔积液等；2）意外脱管；3）置管期间转院或死亡；4）留置导管期间人为调整或改变导管长度。王孟成[11]研究指出，潜变量增长模型样本量至少达200人才能确保模型的稳定性。本研究已经山西白求恩医院 山西医学科学院医学伦理委员会批准（批件号：YXLL-2025-124）。
1.2　研究方法
1.2.1　置管方法
将患儿置于开放式抢救台或暖箱上，全程进行心电监护及经皮血氧饱和度监测。采用含26GA（1.9F）单腔PICC导管专用穿刺包，由2名PICC专科护士严格遵循《新生儿PICC置管操作规范》[12]共同完成置管操作，穿刺途径为上肢静脉或下肢静脉。置管完成后，用6 cm×7 cm无菌透明敷料进行无张力粘贴固定，X线片确认导管位置。置管成功后，按照《新生儿经外周置入中心静脉导管操作及管理指南》[13]、《儿童静脉输液治疗临床实践循证指南》[14]对导管进行日常维护。
1.2.2　PICC导管尖端继发性移位
患儿首次置管时采用X线片常规定位，之后每周采用床旁超声对导管尖端进行定位。导管尖端初始位于理想位置，使用过程中导管尖端偏离至非上腔和下腔静脉内或脐以下下腔静脉内为发生导管继发性移位[15]。
1.2.3　资料收集方法
取得医院伦理审批后，从新生儿科病历系统收集患儿一般资料，包括性别、出生胎龄、出生体重、置管时日龄、置管时体重、肠外营养时间、穿刺部位、穿刺静脉、总置管时间。由同一护士使用婴儿秤测量婴儿体重并记录，精确至1.0 g。体重测量时间为06:00~08:00（2餐奶之间）。体重每周测量1次，PICC置管时为第1次，1周后为第2次，以此类推。体重增长率=[(测量当日体重-置管时体重)/置管时体重]×100%[16]。本研究统计患儿置管后4周体重增长情况。
1.2.4　质量控制
由2名取得PICC专科资格认证的专科护士对患儿胸片分别进行读片，之后交叉对比读片结果。如存在争议，邀请第3名影像科医师进行复读和商定。患儿资料由双人核对录入，如有异常数据，再次检查病历系统核对数据。
1.2.5　统计学方法
采用Mplus 8.3软件构建LCGM识别体重增长轨迹亚组模型，参考指标包括赤池信息准则（Akaike information criterion，AIC）、贝叶斯信息准则（Bayesian information criterion，BIC）、样本校正的贝叶斯信息准则（adjusted Bayesian information criterion，aBIC）、信息熵（Entropy）、罗-梦戴尔-鲁本校正似然比（Lo-Mendell-Rubin adjusted likelihood ratio test，LMRT）、基于Bootstrap似然比检验（Bootstrap likelihood ratio test，BLRT）。确定最佳模型后，采用SPSS 26.0软件进行数据统计分析，符合正态分布的定量资料以均数±标准差（x±s）表示，行t检验；不符合正态分布的定量资料采用中位数（四分位数）[M（P25，P75）]表示，行Mann-Whitney秩和检验；多组间比较采用单因素方差分析或Kruskal-Wallis秩和检验。定性资料以例数、百分比（%）描述，多组间比较采用χ2检验。采用多因素Cox比例风险模型分析患儿导管继发性移位的影响因素并绘制生存曲线，组间比较采用Log-Rank检验。以P<0.05为差异有统计学意义。
2　结果
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2.1　极低出生体重儿的一般资料
220例患儿置管过程中共脱落8例，包括转院4例，意外脱管3例，非计划性出院拔管1例，最终纳入212例患儿。212例患儿中，男115例（54.2%），女97例（45.8%）；出生胎龄25~36（32.08±2.58）周；出生体重1 173.5（1 032.0，1 303.0）g。212例患儿中38例发生继发性移位，移位率为17.9%。
2.2　极低出生体重儿体重增长轨迹
以极低出生体重儿置管后4周体重增长率作为外显指标，依次选取1~5个轨迹类别进行LCGM。当类别数为3个时，BIC最小，AIC、aBIC较小，Entropy较大，同时LMRT和BLRT P均<0.05。虽然2个类别时Entropy值更大，但AIC、BIC、aBIC也较大。综合考虑，最终确定3个轨迹为极低出生体重儿体重增长轨迹的最佳模型。详见表1。
以置管时间为横坐标，体重增长率为纵坐标绘制极低出生体重儿体重增长轨迹图，轨迹1患儿体重增长率在第2周最低，此后逐渐增加，命名为先降后升型，共81例，占38.2%。轨迹2患儿体重增长率在第2周最高，此后逐渐降低，命名为先升后降型，共37例，占17.5%。轨迹3患儿体重增长率在随访时间内稳定上升，命名为相对稳定型，共94例，占44.3%。详见图1。
2.3　不同体重增长轨迹患儿的一般资料（见表2）
2.4　极低出生体重儿PICC导管继发性移位影响因素的单因素分析
单因素分析结果显示，置管时体重、穿刺部位以及体重增长轨迹是极低出生体重儿PICC导管继发性移位的影响因素（均P<0.05），详见表3。
2.5　极低出生体重儿PICC导管继发性移位影响因素的多因素分析
将单因素中有统计学意义的指标（置管时体重、穿刺部位以及体重增长轨迹）纳入多因素Cox回归分析，变量赋值方式见表4。结果显示，穿刺部位、先降后升型和先升后降型体重增长轨迹是极低出生体重儿导管继发性移位的影响因素（P<0.05），详见表5。
2.6　不同体重变化轨迹患儿导管移位的生存分析
绘制3种不同体重增长轨迹亚组的导管继发性移位生存曲线，结果显示，以相对稳定型为参考，先降后升型（χ2=6.786，P=0.005）和先升后降型（χ2=9.861，P<0.05）导管移位发生风险更高，而先降后升型与先升后降型导管移位发生风险差异无统计学意义（χ2=0.507,P=0.476）。见图2。
3　讨论
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3.1　极低出生体重儿体重增长轨迹存在明显群体异质性
本研究结果显示，极低出生体重儿存在3种体重增长轨迹类别，分别为先降后升型、先升后降型、相对稳定型，表明患儿体重增长存在明显群体异质性。高慧[17]研究表明，婴幼儿生长轨迹存在7种亚型，与本研究结果不符。可能原因是本研究纳入样本量偏小，且调查对象仅限于极低出生体重儿，导致部分轨迹类别未被有效识别。3种体重增长轨迹类别中，相对稳定型占比最高，为44.3%。此类患儿表现为体重持续增长，是理想的生长轨迹模式。Chen等[18]研究表明，早产儿在出生后2周到3个月，其体重处于相对稳定的追赶生长期。这是因为早期体重的增加更多地依赖持续的营养供应，而后期则更多受到激素的调节作用[19]。本研究中，有38.2%的患儿属于先降后升型，可能与患儿病情稳定后的快速追赶性生长有关。黄美霞等[20]研究表明，伴有呼吸窘迫综合征、坏死性小肠结肠炎的患儿存在代谢消耗与营养耐受不良，导致生长发育受限，当生长迟缓因素消除后可出现加速生长现象。本研究中17.5%的患儿属于先升后降型，表现为早期体重快速增加，后期增速放缓。可能原因是早期体重增加与医源性液体负荷有关，后期液体调整平衡后导致体重增长变慢[21]。由于体重增长伴随着身体结构的变化，可导致PICC导管尖端发生偏移[22]。因此，医护人员应基于患儿体重增长轨迹类别实施差异化监护，密切关注“先降后升型”和“先升后降型”患儿，先降后升型患儿在后期追赶期需警惕导管张力变化，建议缩短超声定位间隔。而先升后降型患儿应密切关注液体管理，每日评估水肿程度，避免因液体负荷导致导管位移。
3.2　极低出生体重儿导管继发性移位的影响因素
本研究结果显示，先降后升型和先升后降型是PICC导管继发性移位的独立危险因素，表明极低出生体重儿体重增长轨迹可影响导管尖端位置。这是因为先降后升型表现为后期快速追赶生长，身体快速变化造成脊柱伸展或膈肌下移，导致上下腔静脉解剖位置相对于体表穿刺点发生位移，从而使导管尖端位置发生偏移[23]。郑蒙等[24]研究表明，体重增长率快速增长可使早产儿导管移位风险增长，这是因为体重非匀速增长导致血管与导管间产生反复的牵拉，加速导管脱嵌。而先升后降型早期体重快速增长可能伴随中心静脉压升高，血管扩张使导管尖端与血管壁的贴合度降低，稳定性下降[25]。同时，此类型患儿置管2周后体重增长率减慢，水肿消退导致体表至深部血管的垂直距离缩短，使导管容易向远端移位。Tao等[26]研究也证实，非体重线性增长的早产儿PICC导管尖端继发性位移发生率更高。本研究进一步研究发现，先升后降型和先降后升型导管继发性移位风险明显高于相对稳定型，与税晓玉等[27]报道的早产儿体重增长率加快或减慢，导管尖端位置均可能发生改变的结果相一致。本研究生存曲线结果显示，先升后降型患儿导管继发性移位风险最早出现（约置管后12 d），可能与早期体重快速增长导致的血管容积变化直接有关[28]；而先降后升型导管移位风险最早出现时间约为置管后18 d，这可能与后期追赶生长对导管的牵拉效应有关[29-30]。临床护理应建立基于体重增长轨迹的风险分层预警机制。对于先升后降型患儿，建议在置管后第12天左右进行预防性超声检查；对于先降后升型患儿，则在第18天左右加强评估。同时，将患儿体重增长曲线与导管维护记录整合，当曲线出现特定拐点时，专科护士应主动核查导管位置，实现动态风险管理，避免出现尖端移位。
4　小结
收起
本研究发现极低出生体重儿存在3种体重增长轨迹亚组，并且证实先升后降型和先降后升型患儿发生导管继发性移位的风险增高。医护人员可根据患儿置管后体重增长轨迹对导管移位进行危险分层，并实施早期干预措施，以减少导管继发性移位的发生。但是本研究仅分析了患儿置管后4周的体重变化轨迹，4周后体重变化对导管尖端移位的影响尚不清楚；本研究样本量偏小，且病例来源单一，是否存在更多体重变化轨迹亚组还需要更深入的分析。同时本研究仅观察了患儿是否发生导管移位，未明确导管尖端移位的距离。未来可开展多中心、大样本研究，并进一步分析体重增长率与导管尖端移位长度之间的关系。

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doi: 10.12102/j.issn.1009-6493.2026.15.005
  • 接收时间：2025-08-21
  • 首发时间：2026-10-30
  • 出版时间：2026-08-10
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  • 收稿日期：2025-08-21
  • 修回日期：2026-04-29
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    1山西白求恩医院（山西医学科学院），山西医科大学第三医院，同济山西医院，山西 030032

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species		 占总种数比例
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
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