腔内心电图特征性P波振幅在婴幼儿PICC尖端定位中的应用价值  

Application value of the characteristic P wave amplitude of intracavitary electrocardiogram in the tip localization of peripherally inserted central catheter in infants

作　　者：高静芳 张聪聪 朱玉欣 尹欣欣 GAO Jingfang;ZHANG Congcong;ZHU Yuxin(Central Venous Catheter Outpatient Clinic,Shijiazhuang People’s Hospital,Hebei,Shijiazhuang 050000,China)

机构地区：[1]河北省石家庄市人民医院中心静脉导管门诊,050000

出　　处：《河北医药》2023年第5期692-695,共4页Hebei Medical Journal

基　　金：石家庄市科学技术研究与发展指导计划(编号:181460503)。

摘　　要：目的探讨腔内心电图特征性P波振幅在婴幼儿经外周静脉置入中心静脉导管尖端定位的应用价值。方法选取2019年7月至2020年7月住院或门诊经外周静脉置入中心静脉导管和维护的患儿100例,经超声成功置管后行腔内心电图定位并通过X线胸片确定导管尖端位置,按照结果分为A组(理想位置)、B组(位置过深)和C组(位置过浅)。观察患儿特征性P波振幅变化情况并将其与QRS波振幅比值(P/R振幅)分为5个区间段,探讨导管尖端处于3个位置分别对应的区间段,并分析腔内心电图的准确性、特异度、灵敏度等诊断性试验评价指标。结果经定位,A组89例(89.00%)、B组6例(6.00%)、C组5例(5.00%),3组一般资料差异无统计学意义(P>0.05);P/R振幅≤30%区间段除与≥60%区间段(P>0.05)外差异均有统计学意义(P<0.05),P/R振幅31%~40%、41%~50%、51%~60%与>60%区间比较差异均有统计学意义(P<0.05);腔内心电图技术特异度、灵敏度、准确性分别为90.91%、97.75%、97.00%,ROC曲线下面积为0.962。结论腔内心电图定位技术特征性P波振幅可指导婴幼儿经外周静脉置入中心静脉导管尖端定位,在41%~60%区间段定位效果最优,且特异度、灵敏度较高,有望弥补X线定位技术不足以成为定位导管尖端位置的新标准。Objective To investigate the application value of the characteristic P wave amplitude of intracavitary electrogram in the tip localization of peripherally inserted central catheter(PICC)in infants.Methods From July 2019 to July 2020,100 hospitalized or outpatient children indwelled with central venous catheter(CVC)were retrospectively recruited.After the successful catheterization under the guidance of ultrasound,intracavitary electroencephalogram was performed and chest X-ray examination was conducted to localize the tip of PICC.According to the tip localization of PICC,patients were assigned into group A(an ideal localization),group B(a deep lcoalization)and group C(a shallow localization).The changes of characteristic P-wave amplitude and QRS wave amplitude ratio(P/R amplitude)were observed and divided into five intervals.The corresponding intervals of PICC tip at three sites were discussed,and the diagnostic potential of intracavitary electrogram was analyzed by calculating the accuracy,specificity and sensitivity.Results There were 89(89.00%),6(6.00%)and 5(5.00%)cases in group A,B and C,respectively.There was no significant difference in baseline data among the three groups(P>0.05).In addition to the comparison between P/R amplitude≤30%and>60%(P>0.05),significant differences were detected between the 31%~40%,41%~50%and 51%~60%with>60%group(P<0.05).The specificity,sensitivity and accuracy of intracavitary electrocardiography in localizing the tip of PICC were 90.91%,97.75%and 97.00%respectively,and the area under receiver operating characteristic(ROC)curve was 0.962.Conclusion The characteristic p wave amplitude of intracavitary electroencephalogram can guide the tip localization of PICC in infants.The best positioning effect is in the interval of 41%~60%of P/R amplitude,with high specificity and sensitivity.It is expected to make up the shortcomings of X-ray and serves as a novel method to localize the tip of PICC in infants.

关 键 词：腔内心电图 特征性P波振幅 经外周静脉置入中心静脉导管 尖端定位 

分 类 号：R540.41[医药卫生—心血管疾病]