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  

Application of ECG Ⅱ Lead P-wave in Detection and Location of Intracavity Tip in Single-chamber Three-way Valvular Catheter Implantation

作　　者：詹福儿[1] 黄梨花[2] 叶婉玲[1] 张纯[2] 刘琦[1] Zhan Fuer;Huang Lihua;Ye Wanling;Zhang Chun;Liu Qi(Department of Medicine Oncology,Dongguan People's Hospital;Department of Radiotherapy,Dongguan People's Hospital,Dongguan 523059 China)

机构地区：[1]东莞市人民医院肿瘤内科 [2]东莞市人民医院放疗科,广东东莞523059

出　　处：《锦州医科大学学报》2019年第4期17-20,共4页Journal of Jinzhou Medical University

基　　金：东莞市社会科技发展项目,项目编号:2018507150011360

摘　　要：目的探究ECGⅡ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ECGⅡ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ECGⅡ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 was 98.33% 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.

关 键 词：ECGⅡ导联 P波检测 导管尖端 定位 单腔三向瓣膜式导管置入 

分 类 号：R473.73[医药卫生—护理学]