心房内心电图在中心静脉导管定位准确性和安全性的随机对照研究

A randomized controlled study of atrial electrocardiogram for central venous catheter positioning accuracy and safety

目的：探讨在应用Peres’定位法的基础上结合使用心房内心电图，在经颈内静脉行中心静脉置管术中定位导管尖端位置中的临床应用价值。方法2013年1月－2014年1月，共1980例接受颈内静脉置管的成年肿瘤患者（18～88岁）参与研究，共有61例失访。最终1919例患者进入研究，按随机实验法，分为实验组980例，对照组939例。实验组在Peres’公式定位基础上术中使用心房内心电图技术行导管定位，对照组仅使用Peres’定位法进行置管长度预估，通过胸部正位X线了解导管尖端到位情况。结果 Peres’定位结合心房内心电图与单纯使用Peres’定位法两种方法导管尖端到位率分别为99．6％和98．5％；两组最终置管长度差异无统计学意义（P＞0．05）；但使用心房内心电图组导管异位率低于单纯Peres’定位组（ P＜0．05）；心房内心电图组在上腔静脉内的导管X线投影深度较Peres’定位组浅（ P＜0．05）。结论在Peres’定位法基础上术中加用心房内心电图引导技术，可在术中及时发现异位，减少导管异位率，保证置管准确性和安全性。在颈内静脉置管中使用心电图技术，建议以体表定位为参考做适当调整，不建议单独以心电图波形变化决定导管置入长度。

Objective To study the clinical value of intra‐trial electrocardiogram （ECG） during the internal jugu‐lar vein cauterization .Method 1980 cancer patients aged 18‐60 years from Feb .2013 to Feb .2014 were selected for internal jugular vein （IJV） catheterization ,with the loss of 61 cases .In the experiment group ,central venous cathe‐terization was done by the Peres’ formula and ECG guidance .For patients in control group ,the catheter was insert‐ed blindly using Peres’ formula .The position of the tip of central venous catheter was confirmed by postoperative chest X‐ray at upright position .Result 99 .6% of patients in the experiment group had correct positioning of catheter tip ,while in the control group the proportion was 98 .5% .There was no significance difference between the two groups in the insertion depth of catheters .“Peres’ formula＋intra‐trial ECG”group had lower mal‐position rate than“Peres’ formula” group （P〈 0 .05） .The tips of catheters in the superior vena cava by X‐ray of the experiment group were shallower than the control group .Conclusion Intra‐trial ECG technique could upgrade the accuracy and security of internal jugular vein catheterization .We were against insertion depth of catheters decided only by Intra‐trial ECG technology .Intra‐trial ECG technique was recommended combining with Peres’ formula .