腔内心电图用于锁骨下静脉置管定位的临床研究

Clinical study of intracavitary ECG used for subclavian vein catheterization positioning

目的探讨腔内心电图用于锁骨下静脉置管定位的可行性与可靠性。方法将60例择期非心脏停跳下冠状动脉旁路移植术病例随机分到观察组和对照组,每组各30例。观察组用腔内心电图确定导管置入深度,对照组用L=H/10-2(cm)公式计算值确定导管置入深度。导管最终位置通过胸部X线检查确定。结果观察组0例(0%)和对照组例18(60%)导管置入位置异常(过深12例、过浅1例、误入右颈内静脉5例)(P<0.05)。导管置入深度,观察组(12.1±1.1)cm,对照组(14.1±1.4)cm,两者比较差异有统计学意义(P<0.05)。穿刺和置管次数、时间,两组间比较差异无统计学意义(P>0.05)。术中导管使用异常发生率,两组间比较差异有统计学意义(P<0.05)。结论腔内心电图引导右锁骨下静脉置管可靠并且可行,可作为一项常规技术应用于临床。

[Objective ] To investigate the feasibility and reliability of the intracayitary ECG for subclavian vein catheterization. [ Methods ] 60 patients undergoing elective non-cardiac-arrest coronary artery bypass grafting were randomly divided into observation group and control group, 30 cases in each group. The catheter insertion depth was determined by intracayitary ECG in observation group and by the calculation value with L=H/10-2 （cm） formula in control group. The final position of the catheter was determined by chest X-ray examination. [Results] The abnormal catheter position was found in 18 cases （60%） of control group （12 cases of too deep, 1 cases of too shallow and 5 cases of right internal jugular vein catheterization） and 0 case （0%） of observing group （P 〈 0.05）. Catheter inser- tion depth was （12.1 ± 1.1） cm in the observation group and （14.1 ± 1.4） cm in the control group （P 〈 0.05）. The difference comparing between two groups were not significant with the number and the time of puncture and catheterization （P 〉 0.05）. The rate of Intraoperative abnormal use of catheter between two groups had significant difference （P 〈 0.05）. [ Conclusion ] Intracavitary ECG lead right subclavian vein catheterization is reliable and feasible, and can be used as a routine technique in clinical application.