腔内心电图联合体外测量法定位患儿下肢静脉PICC尖端位置准确性和安全性的随机对照研究  

Accuracy and safety of intracavitary electrocardiogram jointing in vitro measurement in locating PICC tip of lower extremity vein in children: a randomized controlled trial

作　　者：杨翠[1,2] 唐梦琳 罗玉兰[1,2] 胡琳 宋锦平[2,1] YANG Cui;TANG Menglin;LUO Yulan;HU Lin;SONG Jinping(West China Hospital/West China School of Nursing,Sichuan University,Sichuan 610041 China)

机构地区：[1]四川大学华西医院,四川610041 [2]四川大学华西护理学院

出　　处：《护理研究》2021年第24期4358-4365,共8页Chinese Nursing Research

基　　金：四川大学华西医院临床研究孵化项目,编号:2018HXFH042。

摘　　要：目的:探讨腔内心电图(IC-ECG)联合体外测量法定位儿童下肢静脉经外周静脉置入中心静脉导管(PICC)尖端位置的准确性和安全性。方法:选择2019年5月—2020年5月在四川省某三级甲等医院小儿重症监护病房(PICU)经下肢静脉置入PICC的患儿(年龄≤14岁)180例。根据随机数字生成器软件生成随机数将研究对象随机分为对照组和试验组,每组90例。对照组采用体外测量法置管;试验组采用体外测量法联合IC-ECG定位技术置管。两组患儿置管固定后均用床旁腹部X线判断导管尖端具体位置,比较两组定位准确率、置管时间和导管相关并发症发生率,分析试验组PICC固定时的P波振幅(P’)与正常体表心电图P波振幅(P)比值(P’/P),获得导管尖端处于最佳位置的变化区间。结果:试验组导管尖端一次到位率明显高于对照组(χ^(2)=27.529,P<0.001);试验组置管时间与对照组比较差异无统计学意义(t=0.741,P>0.05);试验组并发症发生率明显低于对照组(χ^(2)=8.889,P=0.003);试验组90例患儿中,当P’/P≤60%时,导管尖端均不在最佳位置;当P’/P处于80%~100%区间时,导管尖端处于最佳位置的比例均为100%。结论:IC-ECG联合体外测量法定位技术不但能提高导管尖端定位精确度,还能减少导管相关并发症发生;且当P’/P比值在80%~100%区间时,导管尖端定位效果更精确。与仅进行体外测量法相比,具有更高的准确性和安全性。Objective:To investigate the accuracy and safety of intracavitary electrocar-diography(IC-ECG)in locating the tip of peripherally inserted central catheter(PICC)in children’s lower extremity vein.Methods:From May 2019 to May 2020,180 children(age≤14 years old)who received PICC via lower extremity vein in pediatric intensive care unit(PICU)of a third-grade class-A hospital in Sichuan province were selected.According to random number generator software,the subjects were randomly divided into control group and experimental group,with 90 cases in each group.The control group was catheterized by in vitro measurement;the experimental group was catheterized by in vitro measurement with IC-ECG positioning technology.The position of catheter tip was determined by X-ray abdominal film in both groups.The one-time placement rate of catheter tip,catheterization time(from the beginning of needle insertion to catheter fixation)and the incidence of complications were compared between the two groups,the ratio of P wave amplitude(P’)at PICC fixation to normal IC-ECG P wave amplitude(P’/P)was analyzed in the experimental group,and the optimal change range of the catheter tip position was obtained.Results:The one-time catheter tip placement rate in the experimental group was significantly higher than that in the control group(χ^(2)=27.529,P<0.001);there was no significant difference in the average catheterization time between the experimental group and the control group(t=0.741,P>0.05);the incidence of complications in the experimental group was significantly lower than that in the control group(χ^(2)=8.889,P<0.003);when P,/P≤60%,the catheter tip was not in the optimal position;when P’/P was in the range of 80%~100%,the proportion of catheter tip in the optimal position was 100%,which indicated that this interval had the best effect of locating the catheter tip.Conclusion:IC-ECG positioning technology can not only improve the accuracy of catheter tip positioning,but also reduce the incidence of catheter-related complic

关 键 词：腔内心电图 下肢静脉 经外周静脉置入中心静脉导管(PICC) 尖端定位 异位 

分 类 号：R473.72[医药卫生—护理学]