腔内心电图定位技术在儿童输液港植入术中的应用  

Application of intracavity electrocardiography positioning technology in children’s totally implantable venous access ports implantation

作　　者：黎明[1] 刘赞 黄召[1] 刘登辉[1] 唐湘莲[1] 周宇翔[1] 向强兴 文佳冰[1] 李勇[1] Li Ming;Liu Zan;Huang Zhao;Liu Denghui;Tang Xianglian;Zhou Yuxiang;Xiang Qiangxing;Wen Jiabing;Li Yong(DepartmentⅡof General Surgery,Hunan Children’s Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院普外二科,长沙410007

出　　处：《临床小儿外科杂志》2024年第7期672-676,共5页Journal of Clinical Pediatric Surgery

基　　金：湖南省临床医疗技术创新引导项目(2021SK50510)。

摘　　要：目的探讨腔内心电图在儿童输液港植入术中定位导管尖端位置的准确性和安全性。方法以湖南省儿童医院普外二科2020年1月至2023年5月收治的需行输液港植入术的66例恶性肿瘤患儿为研究对象, 采用传统胸部X线定位的34例为对照组, 采用腔内心电图定位的32例为观察组。观察两组患儿定位后导管尖端位于上腔静脉与右心房交界处(cavoatrial junction, CAJ)比例、定位时腔内心电图波形特点、两种定位方法所需时间以及相关并发症发生情况。结果对照组初次置管有25例导管尖端位于CAJ, 初次置管到位率73.5%(25/34);观察组初次置管有30例导管尖端位于CAJ, 置管到位率93.7%(30/32);差异有统计学意义(χ^(2) =4.853, P<0.05)。观察组32例出现双向或倒置P波, 29例出现高振幅的直立特征性P波。对照组C臂定位所需时间为(5.5±1.4)min, 观察组定位所需时间为(2.3±0.6)min, 差异有统计学意义(P<0.05)。两组患儿置管过程中均无一例并发症发生。结论在儿童输液港植入术中, 与传统的胸部X线定位相比, 使用腔内心电图定位导管尖端位置更加快速、准确, 而且安全、有效。对于少部分腔内心电图波形改变不典型的患儿, 需术中C臂或超声辅助定位。Objective To investigate the accuracy and safety of using intracavitary electrocardiography for positioning the catheter tip during children’s totally implantable venous access ports implantation.Methods Sixty-six children who underwent transfusion port implantation in our department were studied.34 children who underwent traditional chest X-ray positioning were in the control group,while 32 children who underwent intracavitary electrocardiography positioning were in the observation group.The study compared the proportion of catheter tips located at the cavoatrial junction(CAJ)after positioning,the characteristics of intracavitary electrocardiography waveforms during positioning,the time required for each positioning method,and the incidence of related complications between the two groups.Results In the control group,the catheter tip was located at the CAJ in 25 cases,with a first-time placement success rate of 73.5%(25/34).In the observation group,the catheter tip was located at the CAJ in 30 cases,with a first-time placement success rate of 93.7%(30/32),showing a statistically significant difference(χ^(2)=4.853,P<0.05).In the observation group,32 cases exhibited biphasic or inverted P waves,and 29 cases exhibited high-amplitude,upright characteristic P waves.The time required for C-arm positioning in the control group was 5.5±1.4 minutes,while the time required for positioning in the observation group was 2.3±0.6 minutes,showing a statistically significant difference(P<0.05).No complications occurred during catheter placement in either group.Conclusions Compared with traditional chest X-ray positioning,using intracavitary electrocardiography for positioning the catheter tip during children’s totally implantable venous access ports implantation is faster,more accurate,safe,and effective.For a small number of children with atypical intracavitary electrocardiography waveform changes,C-arm or ultrasound assistance is needed during surgery for positioning.

关 键 词：腔内心电图 输液港 外科手术 儿童 

分 类 号：R47[医药卫生—护理学]