心电定位PICC穿刺技术的临床应用研究

Application of electrocardiographic method for positioning the tip location of PICC

摘要:

目的：探讨心电定位经外周静脉穿刺中心静脉置管术（peripheral inserted central catheter，PICC）的临床应用效果。方法：将180例PICC置管的肺癌化疗患者随机分为对照组、观察组各90例，再根据穿刺先后顺序将观察组分为观察组1和观察组2各45例。对照组采用常规术后X片定位法；观察组1采用心电定位技术结合术后X光片定位法双重确认导管尖端位置；观察组2采用心电定位技术根据术中P波振幅变化确认导管尖端位置，对无明显P波变化的患者采用术后X片定位法。比较对照组和观察组之间在导管一次到位率、置管耗时及导管相关并发症发生率、置管满意度的差异性，对照组和观察组1之间导管位于最佳位置比例的差异性，观察组1和观察组2之间置管及定位总耗时及并发症发生率的差异性。结果：对照组患者置管总耗时远高于观察组（z=6.364，P=0.000），导管一次到位率、置管满意度低于观察组（?字2=7.745，P=0.005；63.34%/96.67%，P=0.000）；对照组患者PICC到达最佳位置的比例低于观察组1，具有统计学差异（?字2=43.740，P=0.000）；在导管相关并发症上，对照组与观察组、观察组1与观察组2之间均无统计学差异（P>0.05）。结论：心电定位技术安全、准确且能提高导管一次到位率、缩短患者从置管到输液的时间；对P波变化明显的患者，可不必行术后常规X光片检查。

Abstract:

Objective：To investigate the clinical application of intracavitary electrocardiographic（EKG） guided peripheral inserted central catheter（PICC） tip location method. Methods：Totally 180 patients with lung cancer were randomly divided into control group （90 cases） and observation group （90 cases）. Then the observation group were subdivided into observation group 1 and 2 by punc－ture sequence. Routine post-procedure chest X-ray was used to confirm the peripheral inserted central catheter tip location for patients in control group while EKG method was applied for patients in observation group. Post-procedure chest X-ray combined with EKG method was employed in observation group 1 to double confirm the catheter tip location. Chest X-ray was used in observation group 2 only when patients’ P wave change was not observed. The catheter in place rate，operation time，PICC-related complication and pa－tients’ satisfaction were measured and compared between control group and observation group，observation group 1 and observation group 2. The catheter in best place rate was compared between control group and observation group 1. Results：The operation time is statistically shorter（z=6.364，P=0.000），but the catheter in place rate and patients’ satisfaction were statistically increased in observa－tion group than in control group（?字2=7.745，P=0.005；63.34%/96.67%，P=0.000）. The catheter in best place rate was lower in control group than in observation group 1（?字2=43.740，P=0.000）. There was no statistical difference in catheter-related complication between groups（P>0.05）. Conclusion：The EKG method is accuracy，safe and can effectively help the catheter in place as well as reduce the time from catheter insertion to infusion therapy. When P wave change can be clearly observed on EKG，routine post-procedure chest X-ray is unnecessary.