新型静脉内心电图引导PICC导管尖端定位的临床研究

Clinical research on new intravenous electrocardiography guided PICC tip position

目的探讨新型静脉内心电图在PICC置管过程中出现的波形规律性。方法选择符合新型静脉内心电图引导PICC置管的成年患者30例,置管操作在数字减影血管造影室完成。PICC导丝外接心电导线,通过转换器转接监护仪的左腋中线与左肋下缘连接处电极,在推进PICC导管时,记录导管尖端位于锁骨下静脉(A点)、头臂静脉(B点)、上腔静脉上段(C1点)、中段(C2点)、下段(C3点)和右心房入口(D点)、右心房内(E点)7个标志点的新型静脉内心电图和导管插入深度,并与置管前常规体表心电图(O点)作对照。结果 O、A、B、C1、C2、C3、D、E各点P波振幅比较差异有统计学意义(P<0.01)。当PICC导管尖端分别位于A、B、C1、C2、C3、D、E点时导管插入平均深度为41.2cm、43.1cm、45.0cm、48.3cm、51.0cm、53.4cm、56.6cm。结论新型静脉内心电图法引导PICC置管时出现特征性的宽大负向P波与Q波呈"W"波形,标志导管尖端到达上腔静脉下段,是PICC导管尖端的理想位置。

Objective To study the waveform regularity of new intravenous electrocardiography （NVECG） in PICC catheterization. Method Choose 30 cases of adult patients undergoing NVECG guided PICC catheterization in digital subtraction angiography （DSA） room. PICC guidewire is connected to heart electric wire. Then connect it to the electrode on junction between middle line of left axillary and lower position of left rib. Record NVECG and catheter depth when pushing catheter tip to subclavian vein （point A）, brachiocephalic vein （point B）, upper segment of superior vena cava （point C1）, middle segment of superior vena cava （point C2）, lower segment of superior vena cava （point C3）, entrance of right atrium （point D） and inner part of right atrium （point E）. Compare them to routine surface electrocardiogram before catheterization （point O）. Result There is significant difference on P--wave amplitude comparison between point O, A, B, C1, C2, C3, D and E （P〈0. 01）. The average depth are 41.2cm, 43. lcm, 45.0cm, 48. 3cm, 51.0cm, 53.4cm and 56.6cm when PICC catheter tip is on point A, B, C1, C2, C3, D and E. Conclusion Negative wide P--wave and ＂W＂ size of Q-wave during NVECG guided PICC catheterization is the sign of catheter tip reaching lower segment of superior vena cava, which is the ideal position of PICC tip.