静脉内心电图引导经外周静脉植入中心静脉导管尖端定位的效果研究

Study on the effect of tip localization of PICC with the guidance of intravenous ECG

目的:探讨静脉内心电图引导经外周静脉置入中心静脉导管(PICC)技术尖端定位的应用效果。方法:选择医院收治的170例放置三向瓣膜PICC的患者,并严格按照纳入标准进行病例筛选。应用筛检试验对置管后患者的心电图定位方法和X射线片进行对比,并对患者的心电图P波与R波比值(P/R)与心电图P波高度的均数和95%置信区间进行对比分析。结果:应用心电图引导PICC尖端定位的方法,其真实性、实用性及可靠性指标均较好。X射线片与PICC尖端位置判断的特异度、假阳性率、灵敏度、假阴性率和粗符合率分别为91.18%、8.82%、98.43%、1.57%和96.89%,约登指数为0.90、阳性似然比为11.16;心电图定位技术阴性与阳性预测值分别为93.34%、97.66%;房颤患者的X射线片与心电图定位对比,特异度为100%,灵敏度为92.32%;P/R比值和P波高度分别为0.78±0.45和0.92±0.037,95%置信区间分别为0.69~0.87和0.84~0.99;f波高度、f'波高度和(f'-f)/f比值分别为(1.06±0.25)cm、(1.68±0.34)cm和(0.60±0.16),(f'-f)/f比值的95%置信区间为0.52~0.69。结论:房颤患者应用心电图定位PICC尖端位置时,不易导致异位且精准度较高,具有较高的临床应用价值。

Objective:To explore the application effect of tip localization of peripherally inserted central catheter(PICC)was guided by intravenous electrocardiogram.Methods:170 PICC patients with three-way valve were selected,and these cases were screened according to the in strict inclusion criteria.Screening test was used to compare the location method of electrocardiograph(ECG)and X-ray film of patients after catheterization,and the ratio of P wave to R wave(P/R)of ECG,the mean value and 95%confidence interval of P wave height of ECG were further compared and analyzed.Results:The indicators of accuracy,practicability and reliability of ECG-guided PICC tip localization were favorable.The specificity,false positive rate,sensitivity,false negative rate and crude coincidence rate were 91.18%,8.82%,98.43%,1.57%and 96.89%between X-ray film and PICC tip location,respectively.The Youden index was 0.90 and the positive likelihood ratio was 11.16,respectively.And the negatively and positively predictive values of ECG location method were 93.34%and 97.66%respectively.Comparison of X-ray film and ECG location in patients with atrial eminence indicated that the specificity and sensitivity were 100%and 92.32%,respectively.The P/R ratio and P wave height were 0.78±45 and 0.92±0.037,respectively.And 95%confidence intervals were 0.69-0.87 and 0.84-0.99,respectively.The f wave height,f'wave height and the ratio of(f'-f)/f were(1.06±0.25)cm,(1.68±0.34)cm and(0.60±0.16),and the 95%confidence interval of the ratio of(f'-f)/f was 0.52-0.69.Conclusion:It is not easy to cause ectopia when ECG is used to locate the tip of PICC in patients with atrial eminence,and the accuracy is higher.This technique has greater clinical application value.