腔内心电图辅助早产儿PICC导管尖端定位的效果评价

Application of electrocardiogram-guided tip positioning of peripherally inserted central catheter in premature infants

目的探讨腔内心电图辅助PICC导管尖端定位在早产儿PICC置管中的应用效果。方法将2017年6月至2018年3月本院收治行PICC置管的早产儿76例设为对照组,按传统方法行PICC置管后行X线摄片确定导管尖端位置;将2018年4月至2019年3月本院收治行PICC置管的早产儿75例设为观察组,在心电监护下置管,通过心电监护II导联P波的变化确定导管的位置,置管成功后再行X线摄片确定导管尖端位置。比较两组一次性置管成功率、导管异位发生率及导管非计划拔管率的差异。结果观察组一次性置管成功率为97.33%高于对照组78.95%(χ^2=12.153,P=0.001);观察组导管异位发生率为1.33%低于对照组9.21%(χ^2=4.668,P=0.031);观察组非计划拔管率为1.33%低于对照组10.53%(χ^2=5.596,P=0.034)。结论在早产儿PICC置管中采用腔内心电图辅助PICC导管尖端定位,可提高PICC一次性置管成功率,降低导管异位发生率,减少非计划拔管率。

Objective To evaluate the effect of electrocardiogram (ECG) guided tip positioning of peripherally inserted central catheter (PICC) in premature infants. Methods A group of 76 premature infants admitted to the neonatal ward of Hunan Children's Hospital from June 2017 to March 2018 were admitted into control group,where the PICCs were placed,the tips of catheters positioned using X-ray. Another group of 75 premature infants admitted in the same ward during April 2018 to March 2019 were assigned as the observation group,where the PICCs were placed under ECG guidance,with the catheter tips positioned upon the changes of lead II P waves under ECG monitoring. The two groups were compared in terms of one-time success rate,rate of catheter displacement and rate of unplanned extubation. Results The success rate of one-time catheterization in the intervention group was significantly higher than that of the control group (97.33% vs. 78.95%;χ2=12.153,P=0.001). The incidence rate of catheter displacement in the intervention group was significantly lower than that of the control group (1.33% vs. 9.21%;χ2=4.668,P=0.031). The unplanned extubation rate in the intervention group was significantly lower than that of the control group (1.33% vs. 10.53%;χ2=5.596,P=0.034). Conclusion ECG-guided PICC placement and tip positioning can improve the success rate of one-time catheterization,improve work efficiency,reduce the incidence rate of displacement effectively,and reduce the unplanned extubation rate in premature infants.