不同方式腔内心电图定位技术在经上臂静脉植入输液港中的应用研究
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摘要
目的探讨生理盐水导电法与导丝导电法引导腔内心电图定位技术在经上臂静脉植入输液港中的应用效果。方法选择行经上臂静脉输液港植入术的患者110例,随机分成生理盐水导电组和导丝导电组,比较两种方式腔内心电图定位的特征性P波出现率、心电图的稳定性、导管尖端到位准确率、医护满意度和手术时间。结果所有患者在经上臂静脉输液港植入术中均能引导出稳定的腔内心电图,且导管尖端均位于上腔静脉的下1/3段。导丝导电组特征性P波出现率显著高于生理盐水导电组(P=0.028)。生理盐水导电组医护满意度显著高于导丝导电组(P<0.001),患者的阶段手术时间较短(P<0.001)。结论两种方法均能引导出腔内心电图,导丝导电组更易获得标准型P波,生理盐水导电组操作流程的便捷性更高。
Objective To explore the optimal method for guiding totally implantable access port via upper arms using intracavitary electrocardiogram. Methods One hundred and ten patients were enrolled and randomly divided into the guide wire conducting group and the normal saline conducting group. Occurrence rate of P wave with characteristics,stability of electrocardiogram,accuracy of catheter tip position,satisfaction of medical staff and length of operation were compared between two groups. Results The intracavitary electrocardiograms were caught in all patients and were stable,the catheter tip position was located in the inferior 1/3 segment of the superior vena cava.The occurrence rate of P wave with characteristics in the guide wire conducting group was significantly higher than that in the normal saline conducting group(P=0.028). The satisfaction of medical staff in the normal saline conducting group was significantly higher,and length of operation in the normal saline conducting group was significantly shorter than the guide wire conducting group(P<0.001). Conclusion Both methods can obtain intracavitary electrocardiogram,P wave with characteristic can be easily obtained in the guide wire conducting group,whereas the operation process is more convenient in the normal saline conducting group.
Objective To explore the optimal method for guiding totally implantable access port via upper arms using intracavitary electrocardiogram. Methods One hundred and ten patients were enrolled and randomly divided into the guide wire conducting group and the normal saline conducting group. Occurrence rate of P wave with characteristics,stability of electrocardiogram,accuracy of catheter tip position,satisfaction of medical staff and length of operation were compared between two groups. Results The intracavitary electrocardiograms were caught in all patients and were stable,the catheter tip position was located in the inferior 1/3 segment of the superior vena cava.The occurrence rate of P wave with characteristics in the guide wire conducting group was significantly higher than that in the normal saline conducting group(P=0.028). The satisfaction of medical staff in the normal saline conducting group was significantly higher,and length of operation in the normal saline conducting group was significantly shorter than the guide wire conducting group(P<0.001). Conclusion Both methods can obtain intracavitary electrocardiogram,P wave with characteristic can be easily obtained in the guide wire conducting group,whereas the operation process is more convenient in the normal saline conducting group.
引文
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[6]张伟伟,汪姣姣,方云.腔内心电图定位技术对经颈内静脉植入输液港患者的效果观察[J].护理学报,2016,23(20):64-67.
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[9]张晓菊,胡雁,李全磊,等.PICC体外测量方法的系统评价[J].护理学杂志,2014,29(6):78-82.
[10]郭玲,秦英,王国蓉,等.成人中心静脉置管腔内心电图稳定性及影响因素研究[J].中华护理杂志,2015,50(6):724-727.
[11]冯毕龙,姚述远,周素军,等.PICC置管过程中腔内心电图的变化及其对置管操作的指导作用[J].中华护理杂志,2010,45(1):26-28.
[2]Moureau NL,Dennis GL,Ames E,et al.Electrocardiogram(EKG)guided peripherally inserted central catheter placement and tip position:results of a trial to replace radiological confirmation[J].J Assoc Vasc Access,2010,15(1):8-14.
[3]Ortiz-Miluy G,Sánchez-Guerra C.Intracavitary electrocardiogram during the insertion of peripherally inserted central catheters[J].Enferm Clin,2013,23(4):148-153.
[4]Zhou L,Xu H,Liang J,et al.Effectiveness of intracavitary electrocardiogram guidance in peripherally inserted central catheter tip placement in neonates[J].J Perinat Neonatal Nurs,2017,31(4):321-331.
[5]宋健,汪春林,胡君娥.心房内心电图应用于PICC导管头端定位效果Meta分析[J].护理学报,2017,24(13):14-16.
[6]张伟伟,汪姣姣,方云.腔内心电图定位技术对经颈内静脉植入输液港患者的效果观察[J].护理学报,2016,23(20):64-67.
[7]Pittiruti M,Bertollo D,Briglia E,et al.The intracavitary ECGmethod for positioning the tip of central venous catheters:results of an Italian multicenter study[J].J Vasc Access,2012,13(3):357-365.
[8]刘胤佃,何金爱,宋燕伶.腔内心电图对PICC尖端定位效果的Meta分析[J].护理研究,2017,31(36):4646-4652.
[9]张晓菊,胡雁,李全磊,等.PICC体外测量方法的系统评价[J].护理学杂志,2014,29(6):78-82.
[10]郭玲,秦英,王国蓉,等.成人中心静脉置管腔内心电图稳定性及影响因素研究[J].中华护理杂志,2015,50(6):724-727.
[11]冯毕龙,姚述远,周素军,等.PICC置管过程中腔内心电图的变化及其对置管操作的指导作用[J].中华护理杂志,2010,45(1):26-28.