摘要
目的：探讨自制转换器显示腔内心电图联合超声探查在经外周静脉置入中心静脉导管（peripherally inserted central catheter,PICC）尖端定位中应用效果以及P波定位代替X线检测的可能性。方法：选择符合入组条件的PICC置管患者1 028例,按照住院号尾数的奇偶分为实验组（n=513）和对照组（n=515）。实验组通过自制转换器把体表心电图转化为腔内心电图,然后通过观察P波变化和超声探查来检测尖端位置,对照组通过超声探查来检测导管尖端位置,置管后2组患者均拍X线片。记录两组患者的尖端到位情况、异位情况以及实验组P波预测与X线检测结果的一致程度。结果：实验组尖端到位率高于对照组,差异有统计学意义（χ-2=20.475,P=0.000）;对减少不同部位的异位率有统计学意义（P﹤0.05）,但对锁骨下反折以及腋静脉的异位率的差异无统计学意义（χ-2=0.140,P=0.708;χ-2=2.997,P=0.083）;实验组P波预测尖端到位情况与X线检测结果的一致性程度较好（κ=0.877,P=0.000）。结论：应用自制转换器显示腔内心电图联合超声探查可以提高置管成功率,值得在临床推广,对于有特征性P波的患者,腔内心电图P波定位对X线检测定位具有替代效果。
Objective：To determine the application efficacy of the self-made converter displaying the intravenous electrocardiogram combined with ultrasonic test and to explore the possibility of P waves positioning instead of X-ray test in determining terminal tip location when inserting a peripherally inserted central catheter（PICC）. Methods：Totally 1 028 patients inserted with PICCs were assigned to the experimental group（n=513） and control group（n=515） according to the admission number. In experiment group,surface electrocardiogram was converted to endocaridal electrogram by the self-made converter;then the tip location was determined by P wave changes and ultrasonography examination. In control group,the tip location was determined by ultrasonography examination. Finally,X-ray was used to confirm the tip location of all the patients. The tip location,ectopic situation,as well as the congruence of P wave prediction and X-ray test were recorded. Results：Tip in-place rate of the experimental group was significantly higher than that of control group（χ-2=20.475,P=0.000）. There was no significant difference in ectopic rate of subclavian vein reflexion and the axillary vein between the two group（χ-2=0.140,P=0.708;χ-2=2.997,P=0.083）. The congruence rate of P waves prediction and the results of Xray test were good（κ=0.877,P=0.000）. Conclusion：Application of self-made converter displaying the intravenous electrocardiogram combined with ultrasonic test can increase the success rate of PICC catheterization,therefore worth clinical promotion. For patients with characteristic P wave,P wave positioning can replace X-ray test in determining terminal tip location during inserting PICC.
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2015年第12期1576-1581,共6页
Journal of Chongqing Medical University
关键词
腔内心电图
自制转换器
超声探查
经外周静脉置入中心静脉导管
intravenous electrocardiographic
ultrasonic testing
tip location
peripherally inserted central catheter
