B超引导下心电监护定位在新生儿PICC置管中的应用

Clinical studies on the PICC guided by type B ultrasonography and electrocardiography in the newborn

目的:探讨B超引导下心电监护定位在新生儿PICC置管中的应用效果。方法:将110例行PICC置管的患儿,随机分为观察组和对照组各55例。对照组患儿在B超引导下行PICC置管,观察组患儿在B超引导下联合心电监护定位行PICC置管。通过超声探查和特征性P波的变化确定导管的位置。2组患儿在PICC置管后均行X线片,以检测导管尖端位置。记录并比较2组患儿置管一次性到位率、置管时间及出血量等情况。并以X线片尖端定位作为判定金标准,评估心电图特征性P波预测的准确度。结果:观察组患儿PICC置管一次性到位率(96.36%)高于对照组(83.63%),χ~2=4.946,P<0.05)。观察组置管时间短于对照组出血量少于对照组(P<0.05)。观察组患儿特征性P波预测到位准确度为90.91%,其与X线检测到位情况一致性程度高(Kappa=0.548,P<0.001)。结论 :B超引导下心电监护定位可明显提高PICC置管成功率,并能提高一次性到位率,缩短置管时间,减少出血量。特征性P波预测到位情况与X线检测到位情况一致性程度高。

Objective： To investigate the effect of type-B ultrasonography and electrocardiography on the PICC in the newborn. Methods： A total of 110 newborn received the PICC were selected as research objects and randomly divided into the observation group （n=55） and the control group （n=55）. The newborns in control group were inserted under the guidance of type-B uhrasonography, and the newborns in other group were monitored by electrocardiography at the same time. The position of the catheter was detected by uhrasonography and P waves of electrocardiogram. The tip position of the catheter, the one-time success rate, the time of insertion and the amount of bleeding of all newborns in the two groups were recorded and compared. In addition, X-ray was used as a golden standard to assess the accuracy of P wave.Results： The success rate of catheterization of observation group and control groups were 96.36% and 83.63% respectively. It was significantly higher in observation group. The set time and blood loss of observation group were significantly less than that of control group. The prediction accuracy of P waves was 90.91%, the congruence rate of P waves and X-ray detection was good （Kappa=0.548 ,P〈0.001）. Conclusion： Type-B ultrasonography combined with electrocardiography can significantly improve the success rate of PICC insertion, and improve the one-time rate, shorten the time of insertion and reduce the amount of bleeding.