腔内心电图P波比例对新生儿PICC定位效果研究

目的：探讨新生儿PICC静脉腔内心电图尖端定位P波大小与PICC导管尖端在上腔静脉位置的关系及其临床应用效果。方法：选取入住NICU治疗的经上肢PICC置管新生儿184例，采用随机数字表法分为观察组和对照组，各92例。对照组采用常规体表测量和术后胸部X线片定位，观察组应用腔内心电图P波比例和胸部X线片定位，比较2组一次置管到位率及置管用时，并分析不同P波对应的导管尖端位置。结果：观察组新生儿PICC置管一次性到位率为95.65%(88/92),明显高于对照组的81.52%(75/92)(P<0.01);观察组置管用时和穿刺点出血量均明显低于对照组(P<0.01)。观察组1/2～2/3 R波的导管尖端主要到达指南推荐位置，1/3～1/2 R波时导管尖端主要到达上腔静脉上2/3处，2/3～4/5 R波时导管尖端到达指南推荐位置或右心房，不同波段到达位置差异有统计学意义(P<0.01)。结论：静脉腔内心电图P波比例有助于新生儿PICC尖端位置定位。

Effect of intracavitary ECG and P-wave ratio on neonatal PICC localization

ObjectiveTo investigate the relationship between the P-wave size of neonatal PICC intracavitary electrocardiogram (ECG) tip and the position of PICC catheter tip in superior vena cava and its clinical effect.MethodsA total of 184 patients with PICC catheterization were enrolled in the study.They were randomly divided into observation group and control group according to the random number table method, 92 cases in each group.The control group took the regular body surface and the chest X-ray positioning after operation, while the observation group was located by intracavitary ECG P-wave ratio and chest X-ray.The disposable catheter success rate and time of catheterization were compared between the two groups, and the position of catheter tip corresponding to different P waves was analyzed.ResultsThe PICC disposable catheter success rate of the newborns in the observation group was 95.65% (88/92), which was significantly higher than that of the control group (81.52%, 75/92)(P < 0.01).The catheterization time and the puncture site bleeding volume in the observation group were significantly lower than the control group (P < 0.01).In the observation group, the tip of the catheter of 1/2-2/3 R wave was mainly recommended by the guideline, the 1/3-1/2 R wave was mainly 2/3 of the superior vena cava, and the 1/2-2/3 R wave was mainly recommended by the guideline or right atrium, the difference was statistically significant (P < 0.05).ConclusionsThe P-wave ratio of intracavitary ECG is helpful to locate the tip of neonatal PICC.