腔内心电图不同P波在重症患者PICC置管中的应用  

Application of different P waves of intracavitary electrocardiogram in PICC catheterization in critically ill patients

作　　者：陈哲[1] 李竹[1] 聂珊珊 卞晓莉 宋锐 CHEN Zhe;LI Zhu;NIE Shan-shan;BIAN Xiao-li;SONG Rui(The First Affiliated Hospital of Jiamusi University,Jiamusi 154003,China)

机构地区：[1]佳木斯大学附属第一医院,黑龙江佳木斯154003

出　　处：《黑龙江医药科学》2023年第1期4-7,共4页Heilongjiang Medicine and Pharmacy

基　　金：黑龙江省卫生健康委科研课题项目,编号:2020-341。

摘　　要：目的:探讨腔内心电图(EKG)不同P波振幅在重症卧床患者PICC导管尖端定位中的应用效果。方法:观察组为2021-04~2022-06在我院重症医学科行PICC置管的重症患者48例,在送置过程中通过腔内心电图观察P波振幅为QRS波振幅高度30%~50%时的PICC导管尖端位置;对照组选取2019-01~2021-03 PICC置管患者的穿刺记录资料及X线胸片48例,对照组患者观察P波振幅为QRS波振幅高度的50%~80%时的PICC导管尖端位置,然后将两组X线胸片进行分析。结果:观察组患者导管尖端位于上腔静脉与右心房交界处的精准率明显高于对照组,两组比较差异有统计学意义(P<0.01)。结论:重症医学科的重症卧床患者置入PICC导管时,腔内心电图P波振幅为QRS波振幅高度30%~50%时,置管精准率高达85.4%,可作为重症医学科卧床患者理想的PICC导管置管尖端定位指导标准。Objective:To investigate the application effect of different P-wave amplitudes of intracavitary electrocardiogram in PICC catheter tip positioning in critically ill bedridden patients.Methods:The observation group consisted of 48 critically ill patients who underwent PICC catheterization in the Department of Critical Care Medicine of our hospital from April 2021 to June 2022.During the process of catheterization,the position of PICC catheter tip when P-wave amplitude was 30%~50%of QRS amplitude was observed by intracavitary electrocardiogram.The puncture records and chest X-rays of 48 patients with PICC catheterizing from January 2019 to March 2021 were collected in the control group.The position of PICC catheter tip when the P-wave amplitude was 50%~80%of the amplitude of QRS wave was observed in the control group,and then the chest X-rays of the two groups were analyzed.Result:The accuracy rate of catheter tip at the junction of superior vena cava and right atrium in the observation group was significantly higher than that in the control group,and the difference was statistically significant(P<0.01).Conclusions:This study found that when PICC catheter was inserted in critically ill bedridden patients in intensive care unit,when the amplitude of P wave in the luminal ECG was 30%~50%higher than that of QRS wave,the accuracy rate of PICC catheter insertion was as high as 85.4%,which could be used as an ideal guiding standard for PICC catheter tip positioning for bedridden patients in intensive care unit.

关 键 词：EKG PICC导管 重症医学科 

分 类 号：R540.41[医药卫生—心血管疾病]