成人中心静脉置管腔内心电图稳定性及影响因素研究  

The influencing factors of intracavitary electrocardiogram stability during the catheterization of central venous

作　　者：郭玲[1] 秦英[1] 王国蓉[1] 江群[1] 王久惠[1] 

机构地区：[1]四川省肿瘤医院急诊科,成都市610041

出　　处：《中华护理杂志》2015年第6期724-727,共4页Chinese Journal of Nursing

基　　金：四川省卫计委课题(130227)

摘　　要：目的探讨在成人中心静脉置管术中使用腔内心电图行导管头端定位时心电图稳定性及其影响因素，提高腔内心电图定位技术I晦床应用的准确性和可靠性。方法对2013年6～12月行中心静脉置管的患者采用腔内心电图引导定位技术．记录置管过程中患者心电图改变情况．采用非条件logistic回归分析探索腔内心电图稳定性的影响因素。结果共1475例患者符合研究标准，1428例患者在置管术中获得稳定的腔内心电图，总稳定率为96.8％，CVC导管腔内心电图稳定率99．0％，不同支撑导丝直径的两种PICC导管腔内心电图稳定率分别为94．7％和91.3％。单因素分析显示，患者身高、性别、左右侧、基础P波振幅、置管途径、导管类型与腔内心电图稳定性相关（P〈0．05）。多因素logistic回归分析结果显示置管途径对腔内心电图稳定性影响差异有统计学意义（OR=12．982．P〈0．001）。结论成人中心静脉置管腔内心电图稳定性较高，中心静脉导管（CVC）导管置管术中腔内心电图稳定性优于经外周置入中心静脉导管（PICC）。可通过改善导联装置增强联接稳定性，如设计专用导联夹增加导联性能，增强心电图信号；加强操作技术培训．安排专人操作有利于排除环境及操作干扰，提高腔内心电图稳定性。Objective To investigate the influencing factors of intracavitary electrocardiogram stability during the catheterization of central venous,and provide evidence for increasing the reliability of intracavitary electrocardiogram technique. Methods The intracavitary electrocardiograms during the catheterization of central venous were recorded among 1475 cases from June to December,2013. The influencing factors of intracavitary electrocardiogram stability were determined using logistic regression analysis. Results Totally 1428 patients（96.8%） acquired stable intracavi- tary electrocardiogram. The proportion of stable intracavitary electrocardiogram was 99.0% in patients with central venous catheterization （CVC）,94.7% and 91.3% in patients with peripherally inserted central venous catheters （PICC）. Single factor analysis showed that height,gender,basic P-wave,catheterization location and type of catheter were correlated with the stability of intracavitary electrocardiogram. Logistic regression analysis indicated that catheterization location had impact on the stability of intracavitary electrocardiogram（OR=12.982,P=0.000）. Conclusion The stability of intracavitary electrocardiogram via CVC is higher than PICC. It is suggested to improve the performance of lead wire,strengthen technique training and get rid of environmental and operational interference to improve the stability of intracavitary electrocardiogram.

关 键 词：心电描记术 导管植入术 中心静脉 

分 类 号：R472[医药卫生—护理学]