心电图引导心静脉置管技术的临床评估.docVIP

PAGE PAGE 1 心电图引导中心静脉置管技术的临床评估 徐仲煌 谭刚 黄建忠 郭向阳 任洪智 叶铁虎 罗爱伦 中国医学科学院 中国协和医科大学 北京协和医院麻醉科 100730 【摘要】 目的 评估心电图引导技术在临床中心静脉置管中的应用效果。方法 60例临床拟行中心静脉置管的择期手术全麻病人随机分成2组，分别行颈内静脉穿刺置管（组1，n=30）和锁骨下中心静脉穿刺置管（组2，n=30）。采用贝朗公司心电图引导中心静脉穿刺包，穿刺过程中根据P波变化确定导管放置深度。穿刺完毕后记录置管深度，两组各选择10例作后前位胸部X线透视验证导管位置。结果 两组中穿刺成功的病人均呈现典型的金属导丝由上腔静脉进入右心房的P波变化。颈内静脉前路穿刺和锁骨下进路穿刺的置入深度分别为13.57±1.11 cm和12.74±1.31 cm。置管后30分钟内所测得中心静脉压（CVP）均在正常范围内。结论 根据心电图P波变化确定导管放置深度，不仅实时反映导管尖端在上腔静脉内的位置，其放置深度也做到了个体化，另外其所需设备简便，无放射性污染，操作简单，有望成为中心静脉置管技术临床常规监测。 【关键词】 中心静脉置管 术中监测 血流动力学 心电图 Clinical Assessment Use of ECG-controlled Central Venous Catheterization Xu Zhonghuang, Tan Gang, Huang Jianzhong, et al. Department of Anesthesiology, Peking Union Medical College Hospital, 【Abstract】Objective To evaluate the use of ECG-controlled central venous ca 【Abstract】Objective To evaluate the use of ECG-controlled central venous catheterization in clinical practice. Methods 60 patients scheduled for elective operations and central venous catheterization under general anesthesia were randomly allocated into 2 groups with 30 patients in each group. Patients in group 1 received internal jugular vein catheterization, while patients in group 2 received subclavian vein catheterization. ECG-controlled central venous catheterization kits were used; the position of the catheters was determined by the change of P wave. The positions of the catherter were reassured by using posterior-anterior position X-ray examination in 10 patients in each group. Results Typical P wave change presented when metallic leads entered from superior vena cava to right atrium. The depth of the catheter was 13.57±1.11 cm (group 1) and 12.74±1.31 cm (group 2) respectively. The CVP measured within 30min after catheterization was in the normal range. Conclusion The change of P wave can help us determine the real-time position of the catheter, which can individuate the depth of the catheter. This technique requires simple equipment and manipulation without radiate contamina