体外测量法结合腔内心电定位技术确定上臂式输液港导管尖端位置的临床研究

A clinical study on determining the tip position of catheter in upper arm infusion port by in vitro measurement combined with intracavitary electrocardiography

目的比较体外测量法结合腔内心电定位技术与传统体外测量法用于确定上臂输液港导管尖端位置的准确率。方法将2019年8月至2020年4月在西南医科大学附属医院导管门诊植入上臂式输液港的患者130例,按照随机数字表法分为对照组和试验组各65例,分别采用体外测量法(对照组)和体外测量法结合腔内心电定位技术植入(试验组),术后均行X射线确定导管尖端位置,比较两组置入导管尖端位置的准确率。结果试验组植入上臂输液港导管尖端位置一次成功率为98.5%,明显高于对照组90.8%(P<0.05)。对照组6例患者发生导管的体内异位,其中体内导管打折2例,异位于胸壁小静脉1例,异位于对侧头臂静脉2例,异位于颈内静脉1例;试验组未发生导管异位。结论体外测量法结合腔内心电定位技术植入上臂式输液港,可提高导管尖端位置的准确率,减少并发症发生,有效避免反复调整尖端位置给患者带来的痛苦和增加感染的风险,减轻患者的心理和经济负担,提高患者满意度,节约医务人员时间和医疗成本。

Objective To compare the accuracy of determination of the tip position of catheter in upper arm infusion port between in vitro measurement combined with intracavitary electrocardiography and traditional in vitro measurement.Methods According to the method of a randomized controlled study,130 patients who were implanted with upper arm infusion port in the catheter clinic of our hospital from August 2019 to April 2020 were randomly divided into control group and experimental group.The two groups were implanted with in vitro measurement and in vitro measurement combined with intracavitary electrical localization technique,and the tip position of the catheter was determined by chest X-ray after operation.The accuracy of catheter tip placement was compared between the two groups.Results The one-time success rate of the catheter implanted in the infusion port in the experiment group was 98.5%that was significantly higher than 90.8%in the control group(P<0.05).In the control group,6 cases of catheter heterotopia occurred in vivo,including 2 cases of catheter fracture,1 case of heterotopia in small vein of chest wall,2 cases of heterotopia in contralateral brachiocephalic vein and 1 case of heterotopic in internal jugular vein.Ductal ectopia did not occur in the experimental group.Conclusion In vitro measurement combined with intracavitary electrocardiography implanting upper arm infusion port can improve the accuracy of the tip position of the catheter,reduce the occurrence of complications and effectively avoid the risk of pain and infection caused by the second operation.It also reduces the economic burden of the patients,improves the patients satisfaction and saves the medical staff time and the medical costs.