静脉腔内心电图在PICC尖端定位中的应用进展

Research progress of the PICC tip localization by the use of the venous ECG

目前临床PICC尖端定位的方法 主要有体表测量法、X线尖端定位法、B超引导辅助定位和静脉腔内心电图定位.前3种方法 分别存在局限性：个体生理结构的差异可能会影响体表测量结果 的准确性;不同观察者采用影像学定位可能存在视觉和主观判断上的差异,且患者易受到X线辐射;B超引导辅助定位不能显示导管的全程,对一些在中心静脉内打折或导管尖端过深的病例无法进行判断.腔内心电图定位技术通过观察置管过程中心电图上P波的特征性变化来判断导管尖端位置,可在置管过程中及时定位,减少导管尖端位置不正确而引发的风险,避免术后行X线带来的辐射和术后再次调管,降低检查费用.本文综述了PICC尖端定位的方法 、腔内心电图尖端定位的原理、优点、腔内心电图的稳定性及影响因素和提高其稳定性的方法 等方面.

There are several kinds of PICC tip positioning method in clinic at present,including body surface measurement, X-ray tip location, ultrasound guided assisted positioning and venous ECG. The limitations of former three methods were that the physical structure of the individual differences may affect the results of surface measurement accuracy; the differences of visual and subjective judgment may exist between different observers and the patient may easy to be affected by X-ray radiation; B ultrasound guidance assisted positioning can not show the whole process, and some of the central vein in the discount or too deep in the catheter tip can not be judged. The localization of the P wave in the center of the tube was observed by the technique of the intra cavity ECG localization to judge the position of the catheter tip, which can be positioned in a timely manner in order to reduce the risks caused by incorrect position of the catheter tip, avoid postoperative X-ray radiation and readjust the tube, reduce the cost of inspection. This study summarizes the PICC tip localization method, the principle, advantage, stability, influence factor and the method of improving the stability of the electrocardiogram.