心内心电图定位锁骨下静脉穿刺.doc

作者单位：河北省人民医院麻醉科（翟美琴（现石家庄市第二人民医院）、赵砚丽、刘晓明、刘晶晶） 通讯作者：赵砚丽 心内心电图定位锁骨下静脉穿刺 河北省人民医院 050051 翟美琴 赵砚丽 刘晓明 刘晶晶 摘要 目的 评价心内心电图（IVECG）技术监测锁骨下静脉穿刺时中心静脉导管位置的简单性和可行性。方法 选择80例临床拟行中心静脉置管的择期手术的全麻成年患者，随机分为A、B两组（n=40），均于右锁骨下切迹下方1～1.5 cm处右锁骨下静脉穿刺。A组穿刺后，中心静脉导管的留置深度（cm）= [身高（cm）/10]－2，B组应用IVECG技术，依据心内心电图P波的特征表现，确定中心静脉导管置管深度；术毕常规床旁X线正位胸部平片检查确定导管的位置。到位以中心静脉导管尖端位于第三、四胸椎为标准，记录两组的到位情况并计算到位率。结果 两组置管深度分别为15.1±1.2 cm，13.4±0.9 cm(P0.05)；到位率分别为80%和100%(P0.05)。结论 应用心内心电图技术，依据心内心电图P波的特征表现置管，可有效监测中心静脉导管深度的变化，而且对导管未进入上腔静脉的情况也可提供有价值的信息，监测锁骨下静脉穿刺时中心静脉导管位置简单可行，值得临床推广使用。 【Abstract】Objective To evaluate that IVECG is a simple and reliable technique to monitoring the position of the catheter. Methods 80 adult patients scheduled for elective major surgeries and central venous catheterizations undergone general anesthesia were randomly divided into two groups with 40 cases in each group. Patients all received right subclavian vein catheterization . Patients in group A received routine method, the depth of the catheter（cm）= [height （cm）/10]-2 ;Patients in group B adjust the depth of the catheter based on the characters of IVECG. The position of the catheter was reassured by using posterior-anterior position X-ray examination after operation. Results The depth of the catheter was 15.1±1.2 cm，13.4±0.9 cm respectively; the rate of satisfactory catheter tip placement were 75% and 100% respectively. There were obvious statistically significant between two groups (P0.05). Conclusion Place the catheter based on the characters of IVECG can monitoring the variation of the depth of the catheter also provide valuable information that the catheter didn’t place into superior vena cava. It also can reduce costs associated with repositioning procedures. The technique is worth spreading and using in clinic. 中心静脉穿刺导管留置的关键在于将导管尖端定位于上腔静脉近右心房口处。在临床实践中，因导管异位导致心律失常及测压失真极为常见。传统方法是通过X线直视或拍床旁胸片进行导管位置调整，在此过程中不但医患均受X线辐射的污染，而且不适用于导管放置过程中实时监测导管位置的变化。故本研究利用心内心电图技术经锁骨下路锁骨下静脉穿刺观察中心静脉导管的到位情况。 1 资料与方法 1.1 一般资料：选择80例临床拟行中心静脉置管的择期手术的全麻成年患者