腔内心电图在房颤患者PICC尖端定位中的研究

The application of intracavitary ECG in positioning the tip of peripherally inserted central catheters in patients with atrial fibrillation

目的观察持续性房颤患者PICC置入过程中腔内心电图f波形态变化规律与PICC尖端位置的关系,预防导管置入过程中发生异位,指导房颤患者PICC尖端定位。方法选择2014年8月至2019年2月住院的74例需行PICC置管的持续房颤患者,观察置管过程中腔内心电图f波的形态改变,将心电图定位的结果与患者置管后的胸片结果进行对比,以胸片结果为金标准,确定导管尖端位置,计算心电图定位的灵敏度、特异度,探索心电图定位技术在房颤患者中的应用效果。结果74例患者中,2例患者由于各种原因未进行胸片检查,其他72例患者,心电图定位与胸片定位结果比较差异无统计学意义(χ^2=0.2,P>0.05)。置管过程中,心电图f波出现形态变化61例(尖端位置正确59例,尖端位置过浅2例),无明显变化10例(胸片显示尖端位置过浅5例、尖端出现异位2例、尖端位置正确3例),出现干扰波无法判断1例(尖端异位),灵敏度95.7%,特异度80.0%。结论持续房颤律患者的心电图虽P波消失,f波的形态在置管过程中发生了特异性变化,可利用f波的变化判断导管尖端在置管过程中是否发生异位,由于持续房颤患者心电图基线有时难以判断、f波形态不规则,推荐f波较置管前振幅明显增高,后撤导管f波回落,再送入导管f波振幅明显增高为导管尖端位置。

Objective To investigate the changes of f wave in intracavitary ECG in patients with persistent atrial fibrillation during the insertion of peripherally inserted central catheter(PICC),to prevent ectopic occurrence during catheter insertion,and to guide the PICC tip position.Methods A total of 74 patients with persistent atrial fibrillation who were admitted and treated in our hospital from August 2014 to February 2019 were enrolled in the study.The changes of f wave in intracavitary ECG during PICC were observed,and the results of ECG positing were compared with those by chest X-ray examination,and taking chest X-ray examination results as gold standard to decide the position of catheter tip,and to calculate its sensitivity and specificity,safety and accuracy of ECG-guided PICC tip position in patients with atrial fibrillation.Results Among the 74 patients,2 patients did not undergo chest X-ray examination due to various reasons.In the pther 72 patients,there were no significant differences in the results between ECG positioning and chest X-ray positioning(P<0.05).During PICC,61 patients had f-wave changes in ECG,of whom 59 cases had correct tip position,and 2 cases had too shallow tip position,moreover,10 patients had no obvious changes,and X-ray results confirmed that 5 patients had too shallow tip position,2 patients had ectopic tip position and 3 cases were located in the correct position,and 1 case had ectopic tip.The sensitivity and specificity were 95.7%and 80.0%,respectively.Conclusion Although the P wave disappears on electrocardiogram in patients with persistent atrial fibrillation,the f-wave has specific changes during PICC.The change of f-wave can be used to judge whether the catheter tip is ectopic during the catheter insertion.