2种方式经瓣膜式PICC引导腔内心电图效果比较

Comparative study on the the effects of a valve-type PICC catheter-guided intracavity electrocardiogram on ECG positioning

目的探讨经瓣膜式外周置入中心静脉导管(PICC)引导腔内心电图定位影响。方法遴选2018年1月至2019年3月静脉治疗护理门诊85例需要置入瓣膜式PICC拟行周期性输注化疗药物的恶性肿瘤患者或者输注营养及刺激性药物的患者,按随机数表法分为2组,观察组(n=43)采用0.9%氯化钠溶液垂降法,对照组(n=42)采用予人工推注0.9%氯化钠溶液法,观察2组患者术中出血量、0.9%氯化钠溶液用量,及术后24 h内穿刺点出血量、并发症情况。比较2组患者心电图情况、导管头端位置情况、波形中断概率、操作流程便捷性得分等指标。结果观察组患者术中出血量、术后24 h内穿刺点出血量、0.9%氯化钠溶液用量及波形中断率明显低于对照组,而操作流程便捷性得分、出现特征性P波率明显高于对照组,差异均有统计学意义(P<0.05);对照组PICC导管尖端一次性到位率低于观察组(P<0.05);对照组并发症发生率高于观察组(P<0.05)。结论0.9%氯化钠溶液垂降法经瓣膜式PICC引导腔内心电图定位准确性、稳定性较好,出血量和并发症明显减少,患者心电图波较稳定,临床价值显著。

Objective To investigate the effects of a valve-type PICC catheter-guided intracavity electrocardiogram on ECG positioning.Methods A total of 85 patients with malignant tumors who needed to be implanted with valve-type PICC and planned to receive periodic infusion of chemotherapy drugs or the patients who were infused with nutrition and irritant drugs in our hospital’s from January 2018 to March 2019 were enrolled in the study,who were divided into observation group(n=43)and control group(n=42)according to random digital table method observation group(n=43)and control group.The patients in observation group adopted the saline drop method,however,the patients in control group adopted artificial bolus injection of 0.9%sodium chloride solution method.The intraoperative blood loss,the dosege of 0.9%sodium chloride solution,and the bleeding volume in the puncture point within 24 hours after surgery,and the incidence rate of complications as well as ECG,catheter tip position,waveform interruption probability,operation process convenience score and the other indexes were observed and compared between the two groups.Results The intraoperative blood loss,the dosege of 0.9%sodium chloride solution,and the bleeding volume in the puncture point within 24 hours after surgery,and the dosege of 0.9%sodium chloride solution as well as waveform interruption rate in observation group were significantly lower than those in control group,however,the convenience of the operation process score and the characteristic P wave rate were significantly higher than those in control group(P<0.05).The one-time placement rate of PICC catheter tip in control group was significantly lower than that in observation group(P<0.05),and the incidence rate of complications in control group was significantly higher than that in observation group(P<0.05).Conclusion The positioning accuracy of intracavity electrocardiogram via the valve-type PICC guided by saline drop method is better,the bleeding volume and complications are significantly decreased,and the ECG wave is relatively stable,and its clinical value is significant.