心电图引导PICC尖端定位的多中心研究

The ECG method for positioning the tip of peripherally inserted central catheter:results of a multicenter study

目的探讨心电图引导PICC尖端定位的准确性及体外测量长度对最佳置入长度的预测价值。方法便利抽取了全国11个省、市、自治区的18所三级甲等医院的743例置管患者进行心电图引导PICC尖端定位。置管到达最佳位置后,进行胸部X线定位,观察心电图引导PICC尖端定位的准确性。结果 624例患者经心电图引导PICC尖端定位后,X线胸片显示导管尖端均在最佳位置。PICC尖端最佳置入长度与体外测量长度呈正相关(r=0.920,P<0.01)。以PICC最佳置入长度(Y)为因变量,以体外测量长度(X)为自变量,采用逐步线性回归,得出回归方程为:左侧贵要静脉Y=4.290+0.897X(R^2=0.834,F=942.459,P<0.001),右侧贵要静脉Y=3.097+0.922X(R^2=0.855,F=2055,P<0.001)。结论对于心电图有P波的患者,P波变化可用来指导置管操作和预测导管尖端位置,心电图定位可作为一种替代性方法。经贵要静脉置入PICC时,可借助线性回归方程,预测导管置入长度。

Objective To evaluate ECG-aided tip localization of peripherally inserted central catheter（PICC）,and to explore the predictive value of in vitro measurement length to optimal length. Methods Convenience sampling method was used to recruit 743 patients from 18 tertiary hospitals in 11 provinces. Patients received ECG-aided tip localization during PICC placement. After PICC was inserted,orthophoria chest radiograph （OCR） was conducted to check whether the tip position of PICC was appropriate. Results Totally 624 valid questionnaires were collected. OCR showed that all tips of PICCs were located in the optimal position. The optimal length was positively corre- lated with in vitro measurement length （r=0.920,P〈0.01）. Linear regression showed regression equation was Y（the optimal length inserted through left basilic vein）=4.290＋0.897X（in vitro measurement length）（R2=0.834,F=942.459, P〈0.O01）,and Y（the optimal length inserted through right basilic vein）=3.097＋0.922X（in vitro measurement length） （R^2=0.855,F=2055,P〈0.001）. Conclusion Change of P-wave can be used to guide PICC placement and predict tip location. ECG-aided tip localization of PICC is accurate,and can be used as an alternative way. Besides,regres- sion equation can be used to predict the optimal length of PICC.