腔内心电图对PICC尖端定位效果的Meta分析  

Meta analysis of localization effect of PICC tip by intracavitary electrocardiogram

作　　者：刘胤佃 何金爱 宋燕伶 

机构地区：[1]暨南大学附属第一医院 [2]暨南大学

出　　处：《护理研究（下旬版）》2017年第12期4646-4652,共7页Chinese Nursing Researsh

基　　金：广东省科技计划项目;编号:2014A021212218

摘　　要：[目的]评价腔内心电图对经外周静脉穿刺置入中心静脉导管(PICC)导管尖端位置的定位效果。[方法]检索Cochrane Library、PubMed、Science Direct、EBSCO、中国期刊全文数据库(CNKI)、中国生物医学文献库(CBM)、维普数据库(VIP)、万方期刊数据库(WANFANG DATA)使用腔内心电图定位法的随机/半随机对照试验,采用RevMan5.2软件对结局进行统计处理。[结果]共纳入文献17篇,Meta分析结果显示病人先后使用腔内心电图定位法与X线胸片定位法,两种方法在确认导管尖端位置的准确性方面比较差异无统计学意义[OR=1.10,95%CI(0.36,3.35),P=0.87];使用腔内心电图定位法的导管尖端一次性到位率为81.3%(n=1 294),使用体外测量法的导管尖端一次性到位率为67.6%(n=1 105),两者比较差异有统计学意义[OR=4.14,95%CI(2.10,8.17),P<0.000 1];使用腔内心电图定位法的导管尖端异位率为4.4%(n=122),使用体外测量法为13.6%(n=375),两者比较差异有统计学意义[OR=0.24,95%CI(0.16,0.37),P<0.000 01]。[结论]腔内心电图定位法在确认导管尖端是否到位的准确性方面能达到X线胸片定位法的效果,能提高导管尖端一次性到位率、降低导管尖端异位率。建议使用腔内心电图定位法的PICC置管过程中,出现特征性P波病人可考虑免除X线检查。Objective:To evaluate the localization effect of intracavitary electrocardiogram(IC-ECG)on the catheter tip position of peripherally inserted central catheter.Methods:A randomized/semi randomized controlled trial was conducted by retrieving Cochrane Library、PubMed、Science Direct、EBSCO、CNKI、CBM、VIP、Wanfang Data and using IC-ECG positioning method and RevMan5.2 software was used to deal with the final result.Results:A total of 17 articles were included,the results of Meta analysis revealed that patients had used IC-ECG positioning method and X-ray positioning method and there was no statistical difference between the two methods in confirming the accuracy of the catheter tip position[OR=1.10,95%CI(0.36,3.35),P=0.87];the disposable placement rate of catheter tip using IC-ECG positioning method was 81.3%(n=1 294),the disposable placement rate of catheter tip using in vitro measurements was 67.6%(n=1 105),the difference was statistically significant[OR=4.14,95%CI(2.10,8.17),P<0.000 1];the ectopic rate of catheter tip using IC-ECG positioning method was 4.4%(n=122),the ectopic rate of catheter tip using in vitro measurements was 13.6%(n=375),the difference was statistically significant[OR=0.24,95%CI(0.16,0.37),P<0.000 01].Conclusion:The IC-ECG positioning method could achieve the effect of the X-ray location method in confirming the accuracy of the catheter tip and could increase the disposable placement rate of the catheter tip and reduce the ectopic rate of the catheter tip.It was recommended to use the IC-ECG positioning method in the PICC catheterization process,the emergence of characteristic P wave patients may consider exempt X-ray examination.

关 键 词：腔内心电图 经外周穿刺置入中心静脉导管 导管尖端位置 异位 到位 定位 META分析 

分 类 号：R472[医药卫生—护理学]