新型静脉内心电图用于左锁骨下静脉穿刺置管的研究  

A Clinical Trial on Applying NVECG to Left Subclavian Vein Catheterization

作　　者：黄俊伟[1] 王连叶[1] 刘湘杰[1] 黄漫[1] 

机构地区：[1]广东省江门市中心医院麻醉科,广东江门529030

出　　处：《临床医学工程》2011年第1期47-48,共2页Clinical Medicine & Engineering

摘　　要：目的进一步总结新型静脉内心电图(NVECG)在左锁骨下静脉穿刺置管过程中出现的波形规律性。方法选择100例行择期左侧开胸手术的患者,气管插管全身麻醉后行左锁骨下静脉穿刺置管,穿刺成功后将定位导线的两端分别连接导引钢丝和心电图LL电极。在推进静脉导管与导引钢丝时观察NVECG,记录出现p-rRs波(锯齿波)和深大倒P和Q波(W波)时的导管深度。出现W波后,继续将导管尖端推进,记录P波变为双相或正向时的导管深度,再外退导管至出现W波。所有患者术中均由术者用手探查静脉导管尖端在心脏的位置,术后检查X线胸片判断导管尖端位置。结果 100例患者中有96例在置管过程中出现W波,当中有90例由术者探查证实导管尖端位于上腔静脉心房入口上2cm处,术后X线判断导管尖端均位于上腔静脉,预测导管到位率为93.8%。出现锯齿波、W波、正向P波和再次出现W波的导管平均深度分别为7.8cm(7.5～12cm)、16.2cm(14～20cm)、20.1cm(17～22cm)和16.2cm(14～20cm)。结论新型静脉内心电图用于左锁骨下静脉穿刺置管定位具有较高的准确性及简易性,非常适合在临床工作中推广。Objective To further investigate the wave rules in NVECG during the process of left subclavian vein catheterization.Methods Selecting 100 patients scheduled for elective left thoracic surgery to observe the Ⅱ lead ECG.Patients received left subclavian vein catheterization after general anaesthesia.When puncture was successfully completed,both ends of the locator was linked with the guide wire and the electrocardiography in order to monitor the LL lead.The change of NVECG was observed on the monitor while advancing the catheter and guide wire.The depth of the catheter was noted down when p-rRs wave（saw tooth wave）,augmented negative P wave and Q wave（W wave） were detected.Advanced the tip of catheter when W wave was presented.The catheter was noted down when P wave was double or positive wave.Then retreated the catheter until the W wave was presented again（noted as W wave Ⅱ）.The positions of the catheter tip of all the patients were reassured by the surgeon,using X-ray examination after the operation.Results A total of 96 patients were presented with W wave during the operation.90 patients were detected with the catheter tip in the SVC by the surgeon and X-ray examination after the operation.Thus the in-position rate was estimated 93.8%.The average depth of the catheter tip is 7.8 cm（7.5～12 cm）、 16.2 cm（14 ～ 20 cm）、 20.1cm（17 ～ 22 cm）和 16.2 cm（14 ～ 20 cm） respectively,when saw tooth wave,W wave,positive P wave and the W wave Ⅱ were presented.Conclusion The NVECG applied to monitor the position of the catheter tip has higher accuracy and simplicity,which is worthy of wide application in clinical work.

关 键 词：新型静脉内心电图(NVECG) 左锁骨下静脉穿刺置管 

分 类 号：R540.41[医药卫生—心血管疾病]