腔内心电图定位在极低出生体质量儿经外周静脉置入中心静脉置管头端位置定位中的应用  

Application of intracavitary electrocardiogram in positioning central venous catheterization through peripheral vein in very low birth weight infants

作　　者：於澜 蔡璐婷 徐敏娟[3] 顾薇薇[3] YU lan;CAI Lu-ting;XU Min-juan;GU Wei-wei(Zhejiang Chinese Medicine University,Hangzhou,Zhejiang 310053,China;Home ward for newborns,Ningbo Women and Children's Hospital,Ningbo,Zhejiang 315000,China;不详)

机构地区：[1]浙江中医药大学,浙江杭州310053 [2]宁波市妇女儿童医院新生儿家庭化病区,浙江宁波315000 [3]宁波市妇女儿童医院NICU

出　　处：《中国妇幼保健》2023年第16期3131-3135,共5页Maternal and Child Health Care of China

基　　金：浙江省医药卫生科技计划项目(2020KY888)。

摘　　要：目的探讨分析腔内心电图定位技术相较传统胸片定位法在极低出生体质量儿经外周静脉置入中心静脉置管(PICC)头端位置定位中的应用价值。方法选取2021年1月—2022年6月在宁波市妇女儿童医院NICU治疗符合置管指征的60例极低出生体质量儿为研究对象,随机分为对照组和观察组,观察组患儿使用腔内心电图定位技术定位PICC头端位置,对照组患儿按外测量定位穿刺深度留置PICC。两组患儿穿刺后均采用胸片确认PICC头端位置,比较两组方法的到位准确率、相关并发症发生率及定位导管的灵敏度、定位导管的特异度,同时探讨最佳位置时P波振幅占R波振幅的比例。结果观察组患儿定位准确率(83.3%)高于对照组(60.0%),差异有统计学意义(χ^(2)=4.022,P<0.05)。观察组患儿并发症发生率(3.3%)低于对照组(26.7%),差异有统计学意义(P<0.05)。观察组患儿定位导管的灵敏度为91.3%、定位导管的特异度为100.0%。观察组患儿中上肢静脉穿刺的有21例出现特异性P波,经X线胸片验证位于最佳位置,P波比例平均在(0.60±0.12),导管头端在最佳位置T4~T6时,P波比例95%CI为0.56~0.65。结论腔内心电图定位技术对于极低出生体质量儿PICC头端位置的定位具有准确率高,并发症发生率低,定位灵敏度和特异度高等特点,在极低出生体质量儿PICC头端定位方面值得推广。特异性P波比例在0.56~0.65之间时,PICC导管头端95%处于最佳位置T4~T6。Objective To explore and analyze the application value of intracavitary electrocardiogram(ECG)positioning technology compared with traditional chest radiograph positioning method in positioning the head end of central venous catheterization(PICC)in very low birth weight infants.Methods 60 cases of very low birth weight infants who were treated in NICU of Ningbo Women and Children's Hos⁃pital from January 2021 to June 2022 were randomly divided into control group and observation group.The observation group used intracavit⁃ary ECG positioning technology to locate the head position of PICC,while the control group used external measurement to locate the puncture depth and indwelling PICC.After puncture,the head position of PICC was confirmed by chest radiograph in both groups.The accuracy,inci⁃dence of related complications,sensitivity and specificity of positioning catheter were compared between the two groups,and the ratio of P wave amplitude to R wave amplitude in the best position was discussed.Results The localization accuracy of children in the observation group(83.3%)was higher than that in the control group(60.0%),and the difference was statistically significant(χ^(2)=4.022,P<0.05).The incidence of complications in observation group(3.3%)was lower than that in control group(26.7%),and the difference was statistically significant(P<0.05).In the observation group,the sensitivity of locating catheter was 91.3%,and the specificity of loca⁃ting catheter was 100.0%.In the observation group,21 cases of upper limb venipuncture showed specific P wave,which was verified by chest X-ray to be in the best position,and the average P wave ratio was(0.60±0.12).When the catheter head was in the best position T4-T6,the 95%CI of P wave ratio was 0.56-0.65.Conclusion Intracavitary ECG localization technology has the characteristics of high accuracy,low incidence of complications,high sensitivity and specificity in locating the head position of PICC in very low birth weight in⁃fants,and it is worth popularizing in loc

关 键 词：极低出生体质量儿 腔内心电图 经外周静脉置入中心静脉置管 定位 

分 类 号：R722.1[医药卫生—儿科]