心电图引导PICC置管尖端定位临床实践与分析

Analysis of the Clinical Practice of PICC Tip Positioning Guided by Electrocardiogram

目的应用心房内心电图定位,对提高PICC导管首次尖端到位率进行探讨。方法整群选择该院2014年8月—2015年6月诊治的90例符合入选标准需行PICC置管患者,随机分为对照组45例和实验组45例,对照组常规置管后行胸部X线尖端定位,实验组应用心电图定位,以PICC管内的导丝为探测电极,观察心电图P变化,以P波高度为QRS波的50%~80%时的导管尖端位置为固定位置,再行X线定位。结果实验组导管尖端首次到位率（95.6%）高于对照组（88.8%）,两组比较差异无统计学意义,P=0.434。结论心电图引导PICC置管尖端定位技术,与X线胸片定位法相比同样安全、准确,可应用于临床。

Objective To explore the application of electrocardiogram positioning in the atrium to improve the accuracy rate of the first PICC tip positioning. Methods 90 cases whose conditions met the inclusion criteria underwent PICC in our hos-pital from August 2014 to June 2015 were selected and randomly divided into the control group, and the experimental group with 45 cases in each. The control group were treated by conventional PICC with chest X-ray tip positioning. The experi-mental group were treated by PICC with the ECG positioning, the change of the P wave was observed by using the wire in-side the PICC catheter as the exploring electrode, the catheter tip position was selected as the fixation position when the height of P wave was about 50% to 80% of the height of QRS waves, and the X-ray positioning was performed after that. Results The accuracy rate of the first PICC tip positioning in the experimental group was higher than that in the control group（95.6%vs 88.8%）, but with no statistically significant difference, P=0.434. Conclusion PICC tip positioning guided by electrocardiogram is as safe and accurate as the chest X-ray plain film positioning, which can be applied to the clinical practice.