应用心电图技术定位PICC导管尖端位置的临床研究

发布时间：2018-06-02 21:07

本文选题：经外周静脉植入中心静脉导管 + 心电图定位　；参考：《青岛大学》2017年硕士论文

【摘要】：目的利用筛检试验的方法对心电图技术定位三向瓣膜PICC导管尖端位置的准确性以及心电图定位技术的临床应用潜力进行全面系统的评价,同时探讨心电图技术在定位房颤患者PICC导管尖端位置的应用效果。方法首先选取青岛大学附属医院符合纳入标准的170例患者,采用自身对照研究将研究对象使用心电图定位的PICC导管尖端位置与置管结束后拍的X线片进行比较,应用筛检试验的方法对其进行评价,分别计算其真实性指标、可靠性指标以及实用性指标,并计算心电图P波的高度和P/R比值的平均数及其95%的置信区间,从而对导管尖端位置的准确性以及心电图定位技术的临床应用潜力作出较准确全面的判断。然后选取青岛大学附属医院符合纳入标准的56例需行PICC置管的房颤患者,采用自身对照研究的方法将心电图定位的PICC导管尖端位置与研究对象置管后拍摄的X片进行比较,计算其灵敏度、特异度及c2值,同时计算f、f′、(f′-f)/f比值及(f′-f)/f的95%置信区间,以观察心电图定位技术在房颤患者中的应用效果。结果1.利用筛检试验对心电图技术定位三向瓣膜PICC导管尖端位置的准确性及临床应用潜力进行评价,其真实性指标中灵敏度98.43%;特异度91.18%,约登指数0.90,假阴性率1.57%,假阳性率8.82%,粗符合率为96.89%,阳性似然比11.16,阴性似然比0.02,实用性指标中阳性预测值为97.66%,阴性预测值为93.94%,可靠性指标中Kappa指数值为0.91,可以看出心电图定位技术的真实性指标、可靠性指标、实用性指标均较好。2.对留取的心电图P波进行量化,测得P波高度为0.92±0.37cm,95%置信区间为(0.84 0.99),P/R比值为0.78±0.45cm,95%置信区间为(0.69 0.87),为使用心电图定位时对P波的判断提供相对客观的依据。3.利用心电图技术定位房颤患者PICC导管尖端位置,其c2值为0,P0.05差异无统计学意义,因此利用心电图技术定位房颤患者PICC导管尖端位置与使用X线定位差异无统计学意义。4.利用心电图技术定位房颤患者PICC导管尖端位置,计算其灵敏度、特异度,得其灵敏度93.75%,特异度100%,因此利用心电图技术定位房颤患者PICC导管尖端位置的准确性较高且不易发生异位。5.对留取的房颤波形进行量化,得到f波高度为(1.06±0.25)cm、f′波高度为(1.68±0.34)cm、(f′-f)/f的95%置信区间为(0.52,0.69),为今后房颤患者导管尖端定位提供一个相对客观的依据。结论心电图技术可以较精确的定位三向瓣膜PICC导管的尖端位置,其可靠性和实用性较高,临床应用潜力较大,值得在临床推广应用。同时该研究探讨了心电图定位技术在房颤患者中的应用效果,该研究发现利用心电图定位技术可以定位房颤患者PICC导管尖端位置,通过对置管过程中房颤波形变化的判断定位导管尖端的位置,且准确率较高,但由于样本例数较少,还需要进一步探索研究。
[Abstract]:Objective to evaluate the accuracy of electrocardiogram (ECG) technique in locating the tip position of three-way valve PICC catheter and the clinical application potential of electrocardiogram (ECG) localization. At the same time, the effect of electrocardiogram (ECG) in locating the tip position of PICC catheter in patients with atrial fibrillation was discussed. Methods at first, 170 patients who met the inclusion criteria in Qingdao University affiliated Hospital were selected and compared with X-ray films taken after catheter placement by electrocardiogram (ECG). The method of screening test was used to evaluate it, and its authenticity index, reliability index and practicability index were calculated, and the height of P wave and the average of P / R ratio and its 95% confidence interval were calculated. The accuracy of catheter tip position and the clinical application potential of electrocardiogram localization technology are judged accurately and comprehensively. Then 56 patients with atrial fibrillation who needed PICC catheterization were selected from Qingdao University affiliated Hospital. The PICC catheter tip position was compared with the X ray taken by the subjects after catheterization by electrocardiogram (ECG). The sensitivity, specificity and c2 value were calculated. The ratio of fen / f / f and the 95% confidence interval of F / F / f were calculated to observe the effect of electrocardiogram (ECG) localization in patients with atrial fibrillation (AF). Result 1. The accuracy and clinical application potential of electrocardiogram (ECG) technique in locating the tip position of three-way valve PICC catheter were evaluated by screening test. The sensitivity is 98.433.The specificity is 91.18, the Yorden index is 0.90, the false negative rate is 1.57, the false positive rate is 8.82, the crude coincidence rate is 96.89, the positive likelihood ratio is 11.16, the negative likelihood ratio is 0.02, the positive predictive value is 97.66, the negative predictive value is 93.94, the reliability is reliable. The value of Kappa index in sex index is 0.91. it can be seen that the true index of electrocardiogram localization technology. Reliability index and practicability index are all good. 2. 2. The measured P wave height was 0.92 卤0.37 cm ~ (-1) 95% confidence interval was 0.84 0.99 cm ~ (-1) P / R ratio 0.78 卤0.45 cm ~ (-1) 95% confidence interval was 0.69 0.87%, which provided a relatively objective basis for the judgement of P wave when using electrocardiogram. There was no significant difference in PICC catheter tip position between atrial fibrillation patients using electrocardiogram (ECG) technique, and the c2 value was 0 (P 0.05). Therefore, there was no significant difference between electrocardiogram technique and X ray location in atrial fibrillation patients with PICC catheter tip location. 4. Electrocardiogram (ECG) technique was used to locate the tip position of PICC catheter in patients with atrial fibrillation and to calculate its sensitivity and specificity. Its sensitivity 93.75 and specificity 100, so the use of electrocardiogram to locate atrial fibrillation patients PICC catheter tip position accuracy is high and not prone to ectopic .5. The f wave height is 1.06 卤0.25 cm / 'and the 95% confidence interval of f wave height is 1.68 卤0.34 cm / f = 0.52 ~ 0.69 / f, which provides a relatively objective basis for the location of catheter tip in patients with atrial fibrillation. Conclusion the electrocardiogram technique can accurately locate the tip position of the three-way valve PICC catheter, its reliability and practicability are high, and the clinical application potential is great, so it is worth popularizing in clinic. At the same time, the effect of electrocardiogram (ECG) localization in patients with atrial fibrillation was discussed. It was found that electrocardiographic localization could locate the tip of PICC catheter in patients with atrial fibrillation. The location of catheter tip is determined by contrasting the changes of atrial fibrillation waveforms, and the accuracy is high. However, due to the small number of samples, further research is needed.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R472

【参考文献】