腔内心电图定位技术在PICC置管患者带管期间的指导意义

The guiding significance of location technique of endocaridal ECG for patient with catheter of PICC during the period of wearing catheter

目的:探讨腔内心电图定位导管尖端位置技术在外周静脉置入中心静脉导管(PICC)置管患者带管期间的应用效果。方法:选取116例PICC置管患者,在无导丝状态下通过盐水柱引导出腔内心电图定位,其中110例心电图显示P波高耸,4例P波出现M样切迹,2例P波低平。经X射线检查确认2例P波低平患者发生导管异位。结果:经盐水柱导引出腔内心电图后凭借P波的改变可定位PICC置管患者的尖端位置,特异度为98.2%;引导出的腔内心电图与体表心电图P波比较,差异有统计学意义(t=22.194,P<0.05)。结论:无导丝PICC导管,通过引出腔内心电图观察P波的改变,可判断导管尖端位置。该操作简便,对患者无损害,特异性高,降低了患者检查费用,提高了PICC置管患者的安全性,具有良好的临床应用价值。

Objective： To investigate the application effect of location technique of endocaridal ECG at catheter tip of patient with catheter of peripherally inserted central catheter（PICC） during the period of wearing catheter. Methods： 116 patients with peripherally inserted central catheter（PICC） were enrolled into the research. And the location of endocaridal ECG were guided through saline water column under the condition without guiding wire. In these ECG, the results of 110 cases showed P wave was high, and results of 4 cases showed incisura of M shape, and results of 2 cases showed P wave was flatness. As the confirmed results of X-ray, the catheters of 2 patients with flat P wave were ectopic. Results： After endocaridal ECG was guided by using saline water column, the change of P wave could locate the tip location of patients with catheter of PICC, and its specificity was 98.2%. And the difference of P wave between guided endocaridal ECG and ECG of body surface was significant（t=22.194, P〈0.05）. Conclusion： The catheter of PICC that observes the change of P wave by guiding endocaridal ECG can judge the location of the tip of catheter. And this operation is convenient, non-damage, and high specificity. Besides, it can decrease examination cost of patients, and enhance the safety of patient with catheter of endocaridal ECG. Therefore, its clinical application value is well.