心电监护在辅助超声引导下改良塞丁格技术经外周中心静脉置管的临床研究

发布时间：2018-01-05 01:21

本文关键词：心电监护在辅助超声引导下改良塞丁格技术经外周中心静脉置管的临床研究　出处：《中国循环杂志》2016年10期 　论文类型：期刊论文

【摘要】：目的:研究心电监护在辅助超声引导下改良塞丁格技术(MST)经外周中心静脉置管(PICC)并根据心电图变化判断导管末端位置的准确率。方法:104例患者连接心电监护仪,置管时利用导丝与心电监护仪RA导联相连引出腔内心电图,根据P波特征性变化对PICC导管末端位置进行判断,判断结果再与置管后根据X线胸片判断的导管末端位置结果进行比较,比较两种方法判断结果的一致性,计算心电判断法的灵敏度和特异度。结果:104例患者中有100例患者出现特征性P波,心电判断结果与X线胸片判断结果一致率为96.2%。4例未出现特征性P波的患者X线胸片显示,有2例导管末端位于上腔静脉上段、1例位于上腔静脉下端、1例位于对侧头臂静脉。两种方法的判断结果无统计学差异。灵敏度为99%,特异度为100%。结论:心电监护辅助超声引导下改良塞丁格技术PICC时可以根据心电图特征性P波对导管末端位置进行判断,而无需拍摄X线胸片,且此方法不会对患者带来额外的创伤,也无放射性污染。心电监护与临床超声引导下改良塞丁格技术PICC相结合可以使PICC得到更广泛的应用。
[Abstract]:Objective: To study the ECG monitoring under the guidance of modified Seldinger technique in ultrasonic assisted (MST) peripherally inserted central venous catheter (PICC) and to determine the accuracy rate of the catheter tip position according to the ECG changes. Methods: 104 cases of patients with connected ECG monitor, when the catheter guide wire is connected with the use of RA lead ECG leads to endocardial mapping according to the characteristic changes of P wave, to judge PICC catheter tip position, compare the catheter tip location of the results and the judgment result after catheter based on chest X-ray to judge the consistency between the two methods to judge the results of the calculation of sensitivity and specificity of ECG judgment method. Results: 104 cases of 100 patients there is the characteristic of P wave, ECG results and chest X-ray results determine the consistent rate of 96.2%.4 cases without X-ray characteristics showed that patients with P wave judgment, 2 cases of distal end of the catheter in the superior vena cava segment, 1 cases In the superior vena cava is 1 cases in the contralateral brachiocephalic vein. There was no difference between the two methods of judgment. The sensitivity was 99%, specificity was 100%. conclusion: ECG assisted ultrasound-guided modified Seldinger technique PICC according to the ECG characteristics of P wave to judge the position of the catheter tip, without the chest X-ray was taken, and this method does not bring additional trauma to the patient, no radioactive pollution. ECG monitoring and clinical ultrasound-guided modified Seldinger technique combined with PICC can make PICC more widely used.

【作者单位】：锦州医科大学;锦州医科大学附属第一医院肿瘤科;
【分类号】：R472
【正文快照】： 方法:104例患者连接心电监护仪,置管时利用导丝与心电监护仪RA导联相连引出腔内心电图,根据P波特征性变化对PICC导管末端位置进行判断,判断结果再与置管后根据X线胸片判断的导管末端位置结果进行比较,比较两种方法判断结果的一致性,计算心电判断法的灵敏度和特异度。结果:104

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