两种方式经瓣膜式PICC引导腔内心电图稳定性与准确性的对照研究

Stability and accuracy of 2 methods for guiding intracavitary electrocardiography via Groshong peripherally inserted central catheter: a comparison based on 180 cases

目的观察自动泵入生理盐水和人工推注生理盐水对经瓣膜式外周置入中心静脉导管(peripherally inserted central catheter,PICC)引导腔内心电图稳定性和准确性的影响。方法选择本院2016年1-5月恶性肿瘤拟行周期性输注化疗药物需置入瓣膜式PICC患者(≥20周岁),按照随机数字表法分为观察组和对照组,每组90例。观察组予自动泵入生理盐水法经瓣膜式PICC引导腔内心电图,对照组予人工推注生理盐水法。记录各组引导腔内心电图的稳定率、导管头端到位准确率、导管头端异位率、特征性P波出现率、盐水用量、术中出血量、术后24 h内穿刺点出血量、术后14 d内PICC致机械性静脉炎及PICC相关性上肢深静脉血栓发生率。结果观察组引导腔内心电图的稳定率(92.22%)、导管到位准确率(94.44%)、特征性P波出现率(93.33%)明显高于对照组(74.44%、84.44%、80.00%,P<0.05),观察组导管头端异位率(5.56%)、盐水用量(7.24±1.69)m L及术中出血量(2.39±1.01)m L明显少于对照组[15.56%、(26.78±10.52)、(5.34±1.36),P<0.05],观察组术后穿刺点出血量(3.28±1.52)m L、PICC致机械性静脉炎发生率(3.33%)、PICC相关性上肢深静脉血栓的发生率(11.11%)明显少于对照组[(10.42±2.57)m L、11.11%、26.67%,P<0.05]。结论自动泵入生理盐水经瓣膜式PICC引导腔内心电图的稳定性和准确性明显优于人工推注生理盐水,PICC置管术后并发症明显少于人工推注生理盐水。自动泵入生理盐水法更适用于瓣膜式PICC导管头端的定位。

Objective To determine the effects of automatic pumping ot normal sanne and manual injection of normal saline on the stability and accuracy for guiding intracavitary electrocardiography via Groshong peripherally inserted central catheter （PICC）. Methods A total of 180 carcinoma patients （more than 20 years old） undergoing elective periodic infusion chemotherapy through Groshong PICC in our hospital from January to May 2016 were recruited in this study. They were randomly divided into the experimental group and control group （n = 90 for each group ）. The experimental group received normal saline by automatically pumping to guide intraeavitary electrocardiography via Groshong PICC, while those of the control group underwent manual injection. The proportion of stable intracavitary electrocardiogram, accuracy of catheter tip location, rate of ectopie situation, incidence of P-wave signals, amount of normal saline and volume of bleeding at the puncture point within 24 h, and the occurrences of PICC-induced mechanical phlebitis and upper-extremity deep vein thrombosis were recorded and compared between the 2 groups. Results In the experimental group, the proportion of stable intracavitary electrocardiogram （92.22% vs 74. 44% ）, accuracy of catheter tip location （94.44% vs 84.44% ） incidence of P-wave signals （93.33% vs80. 00% ） were significantly higher than those in the control group （ all P 〈 O. 05 ）. While, the rate of ectopic situation （5.56% vs 15.56% ）, amount of normal saline （7.24 ± 1.69 vs 26.78 ± 10.52 mL）, volume ofperioperative bleeding （2.39 ± 1.01 vs 5.34 ± 1.36 mL） were obviously lower in the former than the latter group （ all P 〈 0.05 ）. What＇ s more, the experimental group also had notable reduced bleeding volume at the puncture point （3.28± 1.52 vs 10.42±2.57 mL）, and the occurrences of PICC-induced mechanical phlebitis （3.33% vs 11.11% ） and upper-extremity deep vein thrombosis （11.11% vs 26.67% ） than the control group （all P 〈 0. 05）. Gonclusion Automatic pumping of normal saline is superior to manual injection in stability, accuracy and lower incidences of complications in the guidance of intracavitary electrocardiography via Groshong PICC. So it is more suitable for the positioning of Groshong PICC catheter tip.