心房腔内心电图定位早产儿脐静脉导管尖端位置的临床应用研究

Clinical application study of the intracavitary electrocardiogram-guided implantation of umbilical venous catheter in preterm infants

目的 探讨心房腔内心电图定位早产儿脐静脉导管(UVC)尖端位置的临床应用价值。方法 选取2019年6月至2020年7月由传统方式置入UVC的32例早产儿作为对照组,2020年8月至2021年5月应用腔内心电技术定位方式置入UVC的30例早产儿作为ECG组,采用回顾分析方法,比较两组的UVC一次置入成功率、非计划拔管率及导管相关并发症(导管相关性血流感染、心脏、肝脏、腹腔脏器等并发症)发生率的差异。结果 ECG组一次置入成功率为100%,对照组一次置入成功率71.88%,差异有统计学意义(P<0.01);ECG组非计划外拔管率(10.00%)明显低于对照组(31.25%),差异明显(P<0.01)。同时,ECG组平均留置时间[(6.4±0.46)d]显著长于对照组[(3.3±1.78)d],差异显著(P<0.05);带管期间两组并发症发生率无显著差异(P>0.05)。结论 腔内心电图引导UVC尖端定位技术是一种安全、便捷、有效的术中脐静脉导管尖端定位方式,值得临床推广应用。

Objective to explore the clinical value of locating the tip of umbilical veinous catheter(UVC) in preterm infants with atrial intracardiac electrogram. Methods from June 2019 to July 2020, 32 preterm infants with UVC implanted by traditional methods were selected as the control group, and from August 2020 to May 2021, 30 preterm infants with UVC implanted by intracavitary electrical technology were selected as the ECG group. The success rate of unplanned extubation and the incidence of catheter-related complications(catheter-related blood flow infection, heart, liver, abdominal organs and other complications) were different. Results the success rate of primary implantation was 100% in ECG group and 71.88% in control group(P<0.01);The unplanned extubation rate in ECG group(10.00%) was significantly lower than that in control group(31.25%)(P<0.01). At the same time, the average retention time in ECG group(6.4±0.46) d was significantly longer than that in control group(3.3±1.78) d(P<0.05);There was no significant difference in the incidence of complications between the two groups(P>0.05). Conclusion intracavitary electrogram guided UVC tip localization technique is a safe, convenient and effective method to locate the tip of umbilical vein catheter during operation, which is worthy of clinical application.