PICC置管中腔内心电图P波形态改变与临床价值的分析

谌丽萍　　熊萍　　邓俊敏

[摘要] 目的 探討PICC置管中腔内心电图P波形态改变与临床价值。 方法 选择2017年10月至2019年12月于本院行经外周静脉穿刺中心静脉置管（PICC）术治疗的80例患者作为研究对象，所有患者接受腔内心电引导PICC尖端定位技术引导送管，观察患者的心电监护仪Ⅱ导联，并分析出现特征性高尖P波、双峰P波以及双向P波的引出率和定位准确率。 结果 80例PICC置管患者均为实体或血液恶性肿瘤，排在前三位分别为急性髓系白血病、淋巴瘤及肺癌，分别占21.25%、13.75%和12.50%。80例患者均完成PICC置管，且患者置管后均完成腔内心电图检测，结果表明腔内心电图P波变化，排在前两位的分别为Ⅱ导联有特征性高尖P波和双向P波，分别占93.75%和60.00%。 结论 双峰P波与双向P波、特征性高尖P波可作为定位导管尖端的重要依据，联合双峰P波能较为准确地反映导管尖端进入上腔静脉部位，能准确地定位右心房连接部位，对PICC置管中腔内心电准确引导导管尖端定位具有积极作用。

[关键词] PICC置管;腔内心电图P波形态;双峰P波;特征性高尖P波;双向P波

[中图分类号] R473          [文献标识码] B          [文章编号] 1673-9701（2021）12-0159-04

Analysis of morphological changes and clinical value of intracavity electrocardiographic P-wave in PICC

CHEN Liping   XIONG Ping   DENG Junmin

Department of Hematology， Nanchang First Hospital， Nanchang   330000， China

[Abstract] Objective To explore the morphological changes and clinical value of intracavity electrocardiogram P wave in PICC. Methods Eighty patients who underwent Peripherally Inserted Central Venous Catheters（PICC） in our hospital from October 2017 to December 2019 were selected as the research objects. All patients received intracavitary ECG guided PICC tip positioning technology to guide the tube. The patient's ECG monitor lead Ⅱ was observed. The extraction rate and positioning accuracy of the characteristic high sharp P wave， double peak P wave， and bidirectional P wave were analyzed. Results The 80 patients with PICC catheterization all had solid or hematological malignancies. The top three were acute myeloid leukemia， lymphoma， and lung cancer， accounting for 21.25%， 13.75%， and 12.50%， respectively. Eighty patients completed PICC. After the tube was inserted， the patients completed the intracavitary ECG test. The results showed that the P wave changes in the intracavitary electrocardiogram ranked the top two were characteristic high sharp P wave and bidirectional P wave in the lead Ⅱ， which accounted for 93.75% and 60.00%. Conclusion The double peak P wave， bidirectional P wave， and characteristic high sharp P wave can be used as an important basis for positioning the catheter tip. The combination of the bimodal P wave can better reflect the positioning conditions of the catheter tip entering the junction of the superior vena cava and the right atrium. This positively affects the accurate positioning of the catheter tip by the ECG in the PICC catheter.

[Key words] PICC catheter placement; Intracavitary electrocardiographic P-wave shape; Double peak P wave; Characteristic high sharp P wave; Two-way P wave

经外周静脉穿刺中心静脉置管（PICC）是一种经外周静脉（贵要静脉、肱静脉、头静脉）穿刺置入，导管末端位于上腔中心静脉处的导管，其导管末端的最佳位置在上腔静脉与右心房的连接处。PICC是临床常用的干预手段，广泛用于血液疾病患者的化学治疗，不仅可以避免药物被静脉血流冲稀药物，还可以保护上肢静脉，减轻患者的疼痛，而且该方法操作简单、费用较低，也能预防药物对血管刺激而引发静脉炎，从而有效提高患者的生命质量[1-2]。……