心内心电图技术在PICC置管定位中临床应用.docVIP

心内心电图技术在PICC置管定位中临床应用 　　【摘要】 目的：探讨在心内心电图（IVECG）技术引导下置入PICC导管的可行性。方法：选取符合入组标准的患者88例，配合心内心电图技术引导置入PICC导管，与胸片结果进行对照，观察心内心电图技术的灵敏度和特异度，并计算在胸片上测出的导管头端位于理想位置时的导管长度（L-j）与心电定位方法P波达峰值时的导管长度（L-max）的差值，为指导导管后撤长度提供参考数据。结果：88例患者PICC穿刺后胸片证实导管头端位于上腔静脉84例，心内心电图出现特征性P波者72例，无P波变化16例，经及时调整导管位置后，14例出现特征性P波，2例始终未出现特征性P波变化，胸片显示导管尖端仍位于同侧颈内静脉；与胸片结果比较，心内心电图技术引导诊断导管尖端位于上腔静脉的敏感度为97.67%，特异度为100%；PICC头端理想位置时的导管长度与P波达峰值时的导管长度的差值为（2.7±0.8）cm。结论：应用心内心电图引导技术辅助置管，敏感度和特异度高，可有效监测PICC导管深度的变化，而且对导管未进入上腔静脉的情况也可提供有价值的信息，此方法操作简单易行、安全有效，不增加额外创伤和费用，无放射性污染，可替代传统X线检查来确认导管的位置，值得临床推广使用。 　　【关键词】 心内心电图技术； 导管尖端定位； PICC置管 　　【Abstract】 Objective：To study the feasibility of the intracardiac electrocardiogram （IVECG） guided into PICC catheter.Method：88 patients were selected，and they were all met the inclusion criteria， with intracardiac electrocardiogram technology to guide placement of PICC， the results were compared with chest radiography ， sensitivity and specificity were observed within the heart electrocardiogram technologies and computing in the chest measured catheter the length of the catheter tip in an ideal position for （L-j） and cardiac catheter positioning method P length （L-max） of the peak arrival time difference， as provided reference data for guiding catheter length retreat.Result：88 patients after puncture PICC catheter tip was located in the chest confirmed the superior vena cava 84 cases， the characteristic P wave were 72 cases of ECG heart， no P wave changed 16 cases， after timely adjustment of catheter position， 14 cases appeared P wave characteristics， and 2 cases did not appeared P wave characteristics， chest radiograph showed that still was located in the ipsilateral internal jugular vein catheter tip. Compared with the chest radiograph， the intracardiac electrocardiogram diagnosis technology guide catheter tips in the sensitivity of the vena cava was 97.67%， the specificity was 100%. The length of the catheter length PICC catheter tip location and ideal P arrival at the peak difference was