摘要
目的 探索并讨论经外周静脉置入三向瓣膜式中心静脉导管（PICC）头端到位时腔内心电图P波形态变化规律.方法 选择2015年2月至3月在南京鼓楼医院行PICC置管的21例患者,置管前记录体表模拟Ⅱ导联心电图（A）,置管过程中应用X线透视判断导管头端位置,并通过腔内心电图技术记录导管头端位于锁骨下静脉（B）、上腔静脉（SVC）上1/3段（C1）、SVC中1/3段（C2）、SVC下1/3段（C3）、上腔静脉与右心房（RA）交界区（D）、RA上1/3段（E1）、RA中1/3段（E2）、RA下1/3段（E3）时的模拟Ⅱ导联心电图.观察并比较不同位置时腔内心电图图形变化、P 波振幅及斜率.结果 21例患者均置管成功,平均最大P波振幅（9.65± 2.09）mm及P 波斜率（6.38± 2.27）均出现在RA上部,RA上部与中部所记录的P波振幅及斜率差异均无统计学意义（P=0.36,P=0.26）.χ2检验比较利用P 波振幅和P 波斜率分别判断导管头端是否位于RA上部分别为13例（61.9%）和16例（76.2%）,两种方法差异无统计学意义（P=0.32）.导管头端由交界区进入RA时腔内心电图P波形态主要有3种变化类型.结论 利用腔内心电图特征性P波形态变化可以指导三向瓣膜式PICC导管头端准确定位.
Objective To explore the changing rule of the P-wave form of intracavitary electrocardiogram during the procedure of valved peripherally inserted central catheter intubation（PICC）.Methods A total of 21 pa-tients received chemotherapy in Drum Tower Hospital from February 2015 to March 2015 were enrolled in the stud-y.Saline technique was used to help getting a good intracavitary electrocardiogram（IEGM） trace during valved PICC intubation.Surface（A）electrocardiograms of the patients were recorded before valved PICC intubation.During valved PICC intubation,the IEGMs were recorded when the tips of catheters were in different positions.The amplitudes and slopes of P-wave of different positions were compared with each other.Results Valved PICCs were inserted suc-cessfully in all the patients.The maximum average value of amplitude[（9.65±2.09） mm]and slope（6.38±2.27）of P-wave were recorded in the upper third of right atrium（RA）.There were no statistically significant differences be-tween the value of amplitude,slope of upper third and middle third of RA（P=0.36,P=0,26）.The method of using slope of P-wave to judge whether the tip was in the upper third of RA had no statistical difference with the method of using amplitude of P-wave[13（61.9%）vs.16（76.2%）,P=0.32].There were three types of P-wave form from IEGMs when the tips entered into the upper of RA from super vena cava（SVC）RA junction.Conclusions The typi-cal changes of P-wave form can help operators to place the tip of valved PICC in the right position.
出处
《中华心律失常学杂志》
2017年第5期392-396,共5页
Chinese Journal of Cardiac Arrhythmias
基金
南京市医学科技发展基金重点项目（ZKX15016）
关键词
腔内心电图
中心静脉导管
P波形态
Intracavitary electrocardiogram
Peripherally inserted cental catheters
P-wave form
