腔内心电图双峰P波对PICC尖端定位的指导作用

Directive function of intracavitary electrocardiogram bimodal P-wave in the position of PICC tip

目的探讨心电引导定位技术在PICC置管过程中,腔内心电图双峰P波对瓣膜式PICC尖端定位的指导作用。方法在心电引导下置管时,记录双峰P波、特征性P波的引出情况,以双峰P波对应的导管长度为置入长度,同时记录特征性P波对应的导管长度。对置管前后行CT检查的416例患者进行CT三维重建成像,测量气管隆凸至上腔静脉与右心房交界处的距离,并以此距离作为PICC尖端最佳位置的标准距离。置管后测量X线胸片上气管隆突到特征性P波及双峰P波所对应导管尖端的距离(实际距离),并与标准距离进行自身对照。结果416例患者出现双峰P波168例占40.38%,双峰P波到位精确率为86.31%(145/416),特征性P波的到位精确率为13.69%(23/416)。标准距离为(41.96±9.16)mm,出现特征性P波所对应的实际距离为(48.00±15.18)mm,出现双峰P波所对应实际距离为(45.10±11.16)mm,双峰P波到对照的距离为(1.31±0.33)mm,高尖P波到对照的距离为(6.00±2.88)mm,两者比较差异有统计学意义(t=5.197,P<0.05),且双峰P波到对照距离的标准差更小(0.33<2.88)。结论腔内心电图双峰P波在指导PICC尖端定位的稳定性和精确性要比特征性P波高,对定位PICC尖端最佳位置起到补充和完善作用。

Objective To determine the accuracy of intracavitary electrocardiogram bimodal P-wave and characteristic P-wave in the position of PICC tip. Methods In the process of ECG guided catheterization, the morphological changes of P-wave in the intracavitary electrocardiogram were observed, and the bimodal P-wave and characteristic P-wave were recorded. The corresponding catheter length of the bimodal P-wave and characteristic P-wave were recorded. CT three-dimensional reconstruction was performed on 416 patients who underwent CT examination before and after catheterization. The distance between carina of trachea to superior vena cava and the right atrium junction was measured as best position of PICC and the standard distance. After catheterization, the distance from the tip of catheter to the corresponding catheter length of the bimodal P-wave and characteristic P-wave was measured as actual distance, and compared with the standard distance. Results In 416 cases, 168 patients (40.38%) were bimodal P-wave, and the accurate rate of bimodal P-wave was 86.31%(145/416), and the accurate rate of the characteristic P-wave was 13.69% (23/416). The standard distance was (41.96±9.16) mm, the actual distance of corresponding characteristic P-wave was (48.00±15.18) mm and bimodal P-wave was (45.10±11.16) mm. The distance of bimodal P-wave to control was (1.31±0.33) mm and characteristic P-wave was (6.00±2.88) mm, which was significant statistical difference (t=5.197, P<0.05), and the standard deviation of the distance of bimodal P-wave to control was smaller (0.33<2.88). Conclusions The intracavitary electrocardiogram bimodal P-wave is more accurate than characteristic P-wave in the position of PICC tip and it supplements and improves thePICC's tip position.