腔内心电图在下腔静脉PICC尖端定位中的应用研究

Clinical application of intracavitary electrocardiogram in positioning of PICC catheter tip through inferior vena cava

目的探讨由于各种原因不能经上腔静脉而在下腔静脉中进行经外周静脉穿刺中心静脉置管(PICC)的患者,总结应用腔内心电图辅助技术在下腔静脉PICC尖端定位中特异性P波形态的变化规律。方法根据入排标准,按随机数字表法将受试者分为观察组和对照组,每组各30例。观察组通过股静脉插入中心静脉导管,采用腔内心电图定位技术在置管过程中辅助定位的方法。对照组使用体外测量方法通过股静脉插入中心静脉导管。置管后全部拍摄胸腹部X线平片,比较两组导管尖端到位率,统计观察组心电图定位技术在下腔静脉PICC中出现特异性P波形态变化的规律。结果对照组一次性置管导管尖端到位率86.7%,观察组一次性置管导管尖端到位率为100%。两组间差异有统计学意义(P=0.038)。观察组30例出现特异性P波形态学改变,总结了特异性P波形态变化的规律。结论腔内心电图辅助定位技术可用于定位经股静脉穿刺PICC尖端的精准位置,显著提高了一次性置管的成功率。故此技术应用于PICC经股静脉穿刺达下腔静脉,能降低并发症的发生率,值得临床推广。

Objective To explore the clinical application of intracavitary electrocardiogram in positioning of PICC catheter tip through inferior vena cava and summarize the change rule of electrocardiographic wave during the PICC process.Methods 60 patients who couldn′t receive PICC through precava were recruited from a tertiary hospital and assigned into the intervention group and the control group randomly.Patients in the control group received PICC through inferior vena cava and X-ray was used to confirm the positioning of PICC catheter tip.Patients in the intervention group were checked by intracavitary electrocardiogram.Success rates were compared and the change rule of electrocardiographic wave during the PICC process was summarized.Results The success rate was 100%in the intervention group and 86.7%in the control group.All patients in the intervention group showed the typical change of intracavitary electrocardiogram.Conclusions Intracavitary electrocardiogram can promote success rate of PICC through inferior vena cava and reduce the side effect.It is of great value to generalize intracavitary electrocardiogram in clinical application.