心电图P波检测定位腔内尖端在单腔三向瓣膜式导管置入中的应用
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摘要
目的探究ECG II导联P!波检测定位腔内尖端在单腔三向瓣膜式导管置入中的应用价值。方法研究对象选取我院2016年12月至2018年12月期间收治入院的需要进行单腔三向瓣膜式导管置入的病人120例,按照随机数表法将患者分为观察组和对照组,每组各60例。观察组患者置管时采用ECG II导联P波检测定位置管,对照组患者运用X线定位技术置管。比较两组患者的置管最佳位置到位率、一次到位成功率,分析采用心电P波检测判断导管位置的准确率。结果随着导管尖端进入上腔静脉,P波振幅逐渐升高,在到达上腔静脉与右心房的交界处时到达最高振幅,此后逐渐下降。观察组的最佳位置到位率98. 33%、一次到位成功率93. 33%,对照组为86. 67%和78. 33%,两项指标的组间差异均具有统计学意义(P<0. 05)。观察组有1例(1. 67%)患者在导管尚未进入上腔静脉是即出现P波振幅的升高,有1例(1. 67%)患者的P波振幅峰值出现在右心房上1/3处,当P波振幅为QRS波振幅的40%时,59例(98. 33%)患者成功定位至最佳位置。结论 ECG II导联下的P波检测能够有效定位导管尖端,准确地指导导管置入,不同的P波振幅能够较准确的判断导管的置入位置。该方法具有较高的临床应用价值。
Objective To explore the application value of ECG II lead P-wave in the detection and location of intracavity tip in three-way valvular catheter implantation. Methods 120 patients admitted to our hospital from December 2016 to December 2018 who needed three-way valvular catheter implantation were selected and randomly divided into observation group and control group,with 60 cases in each group. ECG II lead P-wave was used to detect and locate the catheter in the observation group,while X-ray localization technique was used in the control group. The rate of arriving at best position and rate of one-time success of catheterization of the two groups were compared. The accuracy of ECG P-wave to detect the position of catheter was analyzed. Results As the tip of the catheter entered the superior vena cava,the amplitude of P-wave increased gradually. P-wave reached the highest amplitude at the junction of the superior vena cava and the right atrium,and then the amplitude decreased gradually. The rate of arriving at best position was98. 33% and the rate of one-time success was 93. 33% in the observation group,while the two indexes were 86. 67% and 78. 33% respectively in the control group,with statistically significant difference( P<0. 05). In the observation group,one patient( 1. 67%) had an increase in the P-wave amplitude before the catheter entered the superior vena cava,and one patient( 1. 67%) had an amplitude peak at 1/3 of the right atrium. When the P-wave amplitude reached 40% of the QRS wave amplitude,the catheter tip was successfully located in the best position in 59 patients( 98. 33%). Conclusion ECG II lead P-wave detection can effectively locate the tip of catheter and accurately guide the catheter placement. Different P-wave amplitudes can accurately determine the location of catheter placement,which has high clinical application value.
Objective To explore the application value of ECG II lead P-wave in the detection and location of intracavity tip in three-way valvular catheter implantation. Methods 120 patients admitted to our hospital from December 2016 to December 2018 who needed three-way valvular catheter implantation were selected and randomly divided into observation group and control group,with 60 cases in each group. ECG II lead P-wave was used to detect and locate the catheter in the observation group,while X-ray localization technique was used in the control group. The rate of arriving at best position and rate of one-time success of catheterization of the two groups were compared. The accuracy of ECG P-wave to detect the position of catheter was analyzed. Results As the tip of the catheter entered the superior vena cava,the amplitude of P-wave increased gradually. P-wave reached the highest amplitude at the junction of the superior vena cava and the right atrium,and then the amplitude decreased gradually. The rate of arriving at best position was98. 33% and the rate of one-time success was 93. 33% in the observation group,while the two indexes were 86. 67% and 78. 33% respectively in the control group,with statistically significant difference( P<0. 05). In the observation group,one patient( 1. 67%) had an increase in the P-wave amplitude before the catheter entered the superior vena cava,and one patient( 1. 67%) had an amplitude peak at 1/3 of the right atrium. When the P-wave amplitude reached 40% of the QRS wave amplitude,the catheter tip was successfully located in the best position in 59 patients( 98. 33%). Conclusion ECG II lead P-wave detection can effectively locate the tip of catheter and accurately guide the catheter placement. Different P-wave amplitudes can accurately determine the location of catheter placement,which has high clinical application value.
引文
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[12]赵京雷,于新颖,范玲.改良心房内心电导联技术在极低出生体质量儿PICC定位中的应用[J].中国医科大学学报,2017,12(10):96-99.
[2]程书栋,王迎春,张会君,等.防漏膏在PICC置管术渗液中的应用[J].锦州医科大学学报,2018,39(1):90-93.
[3] Bernasconi F,Zanaboni C,Dato A, et al. Atypical use of PICC in Infants and Small Children:A Unicentric Experience[J]. The Journal of Vascular Access,2017,18(6):535-539.
[4]徐志宾,施瑜,徐远,等. PICC置管术后导管头端定位点的选择及临床应用[J].实用医学杂志,2017,12(2):149-151.
[5] Badheka A,Brown K,Allareddy V. Peripherally inserted central catheter(PICC)placement:beware of the bends[J]. Bmj Case Reports,2018,18(13):2468-2471.
[6] Paquet F,Boucher LM,Valenti D,et al. Impact of arm selection on the incidence of PICC complications:results of a randomized controlled trial[J]. Journal of Vascular Access,2017,18(5):359-361.
[7] Liu B,Sun W,Wang K. A successful insertion of PICC in patient with cardiac angiosarcoma and neoplasty of right atrium and pacemaker:A case report[J]. Medicine,2017,96(51):9225.
[8]李黎,陈月香,李向君,等. PICC置管中腔内心电图P波形态改变及临床意义的研究[J].护士进修杂志,2017,24(6):712-714.
[9]刘春丽,刘腊根,陈传英,等. PICC置管实时尖端定位方法的现状及进展[J].护理学报,2017,31(9):518-520.
[10] Kleidon T,Ullman AJ,Zhang L,et al. How Does Your PICCOMPARE? A Pilot Randomized Controlled Trial Comparing Various PICC Materials in Pediatrics[J]. Journal of Hospital Medicine,2018,13(8):1335-1338.
[11] Janakos M,Haustein D,Panchang P. Poster 218:Musculocutaneous Neuropathy Due to PICC Line Insertion:A Case Report[J]. PM&R,2017,9(9):202.
[12]赵京雷,于新颖,范玲.改良心房内心电导联技术在极低出生体质量儿PICC定位中的应用[J].中国医科大学学报,2017,12(10):96-99.