心腔内电图特异性Q波在上臂输液港导管尖端定位中的应用  

Application of Intracardiac Electrocardiogram specific Q wave in locating the tip of catheter in upper arm infusion port

作　　者：蒋开明[1,2] 江玉莹 张玉芳[1,2] 罗利 郭亮[2] 周雯[1] Jiang Kaiming;Jiang Yuying;Zhang Yufang;Luo Li;Guo Liang;Zhou Wen(Clinical Nursing Teaching and Research Section,the Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院临床护理学教研室,湖南长沙410011 [2]中南大学湘雅二医院血液内科,湖南长沙410011

出　　处：《护理学杂志》2023年第5期5-8,共4页Journal of Nursing Science

基　　金：中南大学湘雅二医院护理科研项目(2019-HLKY-37);湖南省卫生健康委科研项目(202214013601)。

摘　　要：目的探讨在上臂输液港植入过程中,心腔内电图特异性Q波对导管尖端定位的指导作用。方法将应用心腔内电图定位技术辅助上臂输液港植入的患者124例,根据心腔内电图P波形态的不同分为观察组(非单纯高尖P波)63例和对照组(单纯高尖P波)61例。观察组应用特异性Q波定位法确定导管置入长度,对照组按中华护理学会发布的团体标准《PICC尖端心腔内电图定位技术》确定导管置入长度。通过X线检查,比较两组导管尖端定位精准率,同时比较观察组自身分别应用体表测量法、P/R波振幅50%定位法、双峰P波定位法所对应的导管长度与实际置入长度的差异。结果观察组和对照组导管尖端位于上腔静脉与右心房的交界处及上腔静脉下1/3段的定位精准率分别为98.41%、100%,差异无统计学意义(P>0.05),观察组中体表测量法、P/R波振幅50%定位法所对应的导管长度显著小于实际置入长度(均P<0.05),双峰P波定位法对应的导管长度与实际置入长度差异无统计学意义(P>0.05)。结论对于心腔内电图表现为非单纯高尖P波形态的患者,特异性Q波定位法具有较好的精准度和适用性,可作为心腔内电图定位技术的补充。Objective To explore the guiding effect of Intracardiac Electrocardiogram specific Q wave on catheter tip localization du-ring the implantation of upper arm infusion port.Methods A total of 124 patients undergoing Intracardiac Electrocardiogram assis-ted upper arm infusion port implantation were divided into an intervention group(non-purely hightip P wave)with 63 cases and a control group(purely high-tip P wave)with 61 cases according to the P wave shape in electrocardiography.In the intervention group,specific Q wave localization method was used to determine the length of catheter insertion.In the control group,the length of catheter was determined according to the group standard of the Intracardiac Electrocardiogram method for positioning the tip of peripherally inserted central catheter released by the Chinese Nursing Association.X-ray examination was performed to compare the accuracy of catheter tip location between the two groups.At the same time,the difference between the actual length of the catheter and the length of the catheter determined by using the body surface measurement,the P/R wave amplitude 50%localization,and the double peak P wave localization respectively in the intervention group.Results The accuracy percentage of catheter tip location in cavoatrial junction and lower 1/3 segment of superior vena cava were 98.41%and 100%respectively in the intervention group and the control group,there was no significant difference between the two groups(P>0.05).In the intervention group,the length of the catheters determined by body surface measurement and 50%P/R wave amplitude localization were significantly shorter than the actual length of catheters(both P<0.05),while there was no significant difference when the length of the catheters deter-mined by using the double peak P wave localization(P>0.05).Conclusion The specific Q wave localization method is more accu-rate and applicable for the patients with non-purely high-tip P wave,so it can be used as a supplement of Intracardiac Electrocar-diogram locali

关 键 词：上臂输液港 心腔内电图 单纯高尖P波 特异性Q波 定位 导管置入长度 导管尖端位置 

分 类 号：R472[医药卫生—护理学]