彩色多普勒超声与腔内心电图定位法对预防PICC异位的临床观察

The efffcets of color Doppler ultrasonography and intracavitary electrocardiogram localization method in the prevention of PICC ectopia

目的通过比较彩色多普勒超声与腔内心电图两种定位法对预防PICC异位的效果观察,以期发现PICC置管更优化的定位方法。方法收集在石家庄市第一医院置入PICC的临床病历共计553例,超声组281例和腔内心电图组271例,比较2组PICC导管到位率、两种导管过程异位及最终异位以及两种定位方法对导管异位敏感性对比。结果 2组导管最终到位率差异无统计学意义(χ^2=0.118P=0.078);2组置管过程中过程异位与最终异位比较,差异无统计学意义(χ^2=0.440 P=0.252);两种定位方法对导管异位敏感性对比,差异有统计学意义(χ^2=0.071 P=0.043)。结论超声探头探查导管和腔内心电图定位方法都能发现一部分导管的异位,置管过程中利用超声结合心电图定位方法是预防过程异位的最佳方法,一定程度上可以取代胸片定位方法,两种定位方法结合对降低导管最终异位具有临床意义。

Objective By comparing the effects of two localization methods of color Doppler ultrasound and intracavitary electrocardiogram(ECG) in preventing PICC ectopia in order to find a better localization method for PICC catheterization. Methods The patients who underwent PICC catheterization were divided into two groups: ultrasound group and ECG group.The color Doppler ultrasound was used to detect the ectopic position of the internal jugular vein and right atrial catheter by ultrasound probe in ultrasound group,and the intracavitary ECG was used to detect whether the catheter was in place by observing the changes of the characteristics of P wave. The clinical data of 583 patients who underwent PICC catheterization in our hospital January 2015 to December 2016 were collected, in which,there were 281 cases in ultrasound group and 271 cases in ECG group. The rate of PICC catheter placement,catheter process ectopia and final ectopia, and the sensitivity of two kinds of localization methods to catheter ectopia were observed and compared between the two groups. Results There was no significant difference in the final catheter placement rate between the two groups(χ^2 =0.118,P>0.05), and there were no significant differences in catheter process ectopia and final ectopia between the two groups(χ^2=0.440,P>0.05). However there was significant difference the in the sensitivity of two kinds of localization methods to catheter ectopia between the two groups(χ^2 =0.071,P<0.05). The sensitivity to catheter ectopia in ECG group was higher than that in ultrasound group.Conclusion Both examination methods can detect some catheter ectopia, but both methods have their own shortcomings. Ultrasound combined with ECG positioning method is the best way to prevent ectopic catheters during catheterization, which can replace chest radiography positioning method to a certain extent. The combination of the two positioning methods has clinical significance in reducing the incidence of catheter final ectopia.