中心静脉压力波形指导耐高压注射型经外周置入中心静脉导管尖端定位的临床应用

Clinical Application of Central Venous Pressure Waveform Guided Placement of the Tip of the Power Peripherally Inserted Central Catheter

目的探讨中心静脉压力波形指导耐高压注射型经外周置入中心静脉导管(power peripherally inserted central catheter,Power PICC)尖端定位方法在临床的应用效果。方法便利抽样法选择2015年1月至2016年2月,在徐州市中心医院住院行Power PICC置管的68例患者为研究对象,按随机数字表法将其分为观察组和对照组各34例,观察组应用压力传感器测定周围静脉压并使用中心静脉波形进行定位后,再行胸部X线定位,双重确认Power PICC导管尖端位置;对照组常规体表定位后置入导管,到达拟定长度后行胸部X线定位。比较两组患者的置管位置准确率、置管时间以及并发症的发生情况。结果观察组置管尖端位置准确率为97.1%,对照组为82.4%,差异有统计学意义(χ2=3.981,P<0.05);观察组操作时间(20.3±2.4)min,对照组为(24.3±4.4)min,差异有统计学意义(t=4.715,P<0.05);两组置管患者相关并发症发生率比较,差异无统计学意义(均P>0.05)。结论应用中心静脉波形指导Power PICC置管,能够及时、准确判断导管尖端位置,可有效提高Power PICC置管过程中尖端定位的准确率。

Objective To investigate the application effect of central venous pressure（CVP）waveform guided placement of the tip of the power peripherally inserted central catheter（Power PICC）.Methods From January2015 to February 2016,a total of 68 patients received power PICC in Xuzhou Central Hospital were selected by using convenience sampling method.These patients were randomly divided into observation group（n=34）and control group（n=34）.Inobservationgroup,all patients underwent CVP measurement by pressure sensor and CVP waveform was used to guide placement of the tip of the Power PICC.Afterwards,the location of the Power PICC tip was confirmed by the X-ray again.Incontrolgroup,the placement of Power PICC was guided by body surface localization.After reaching the expected length of the tube,the location of the Power PICC tip was confirmed by the X-ray again.The accuracy rate,operation time,and complication rate were compared between two groups.Results The accuracy rate of placement of the tip of the Power PICC was significant higher in the observation group than that in the control group（97.1%vs 82.4,χ~2=3.981,P〈0.05）.The operation time was significant shorter in the observation group than that in the control group（20.3±2.4 min vs 24.3±4.4 min,t=4.715,P〈0.05）.No statistical significance of the incidence of complication was found in two groups（all P〉0.05）.Conclusions CVP waveform guided placement of the Power PICC can exactly locate the tipofthePICC.Itcaneffectively improve the accuracy rate of placement of the Power PICC.