目的 探讨心电监护仪辅助定位法在新生儿通过下肢静脉进行经外周静脉穿刺的中心静脉导管（peripherally inserted central venous catheter，PICC）置管中的应用效果。 方法 选取2020年1月至2022年1月入住新生儿重症监护室（neonatal intensive care unit，NICU）经下肢静脉行PICC置管患儿120例，按随机数字表法分为对照组和观察组，每组60例。对照组患儿行体表测量+术后胸部X线检查定位；观察组患儿行体表测量+心电定位+术后胸部X线检查定位。收集并比较2组患儿的一般资料、置管一次性到位率及置管耗时，并评估心电定位效率。 结果 观察组置管一次性到位率高于对照组（92% vs 75%；P<0.05），且置管耗时短于对照组［26.5±3.0）min vs（31.8±2.8）min；P<0.05］。心电监护仪辅助定位技术在新生儿经下肢静脉行PICC置管中具有较高的灵敏度（90.9%）和特异度（100%）。 结论 在新生儿经下肢静脉行PICC置管过程中，利用心电监护仪辅助判断导管尖端位置，可提高置管一次性到位率，减少置管耗时，并具有良好的定位效率。
Abstract
Objective To study the efficiency of electrocardiogram (ECG) monitor for positioning the catheter tip in the placement of peripherally inserted central venous catheterization (PICC) via lower extremity veins in neonates. Methods A total of 120 neonates who were admitted to the neonatal intensive care unit from January 2020 to January 2022 and received PICC via lower extremity veins were enrolled and divided into a control group and an observation group using a random number table (n=60 each). The neonates in the control group were given body surface measurement and postoperative chest X-ray localization, and those in the observation group were given body surface measurement, ECG-guided positioning, and postoperative chest X-ray localization. The two groups were compared in terms of general information, one-time success rate of PICC placement, and time spent on PICC placement, and the efficiency of ECG-guided positioning was evaluated. Results Compared with the control group, the observation group had a higher one-time success rate of PICC placement (92% vs 75%; P<0.05) and a shorter time spent on PICC placement [(26.5±3.0) min vs (31.8±2.8) min; P<0.05]. ECG-guided positioning had a sensitivity of 90.9% and a specificity of 100% in the PICC placement via lower extremity veins in neonates. Conclusions ECG monitor helps to determine the position of catheter tip in the PICC placement via lower extremity veins in neonates and can improve the one-time success rate of PICC placement and reduce the time spent on PICC placement, with a good positioning efficiency.
关键词
经外周静脉穿刺的中心静脉导管 /
下肢静脉 /
导管尖端定位 /
心电监护仪 /
新生儿
Key words
Peripherally inserted central venous catheter /
Lower extremity vein /
Catheter tip positioning /
Electrocardiogram monitor /
Neonate
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参考文献
1 吴文理, 陈佩仪, 宋燕伶, 等. 腔内心电图技术用于新生儿PICC置管头端定位的效果观察[J]. 实用医学杂志, 2016, 32(20): 3443-3445. DOI: 10.3969/j.issn.1006-5725.2016.20.045.
2 罗珍, 陈海燕. 新生儿经下肢静脉留置PICC应用的研究进展[J]. 中国护理管理, 2018, 18(10): 1414-1417. DOI: 10.3969/j.issn.1672-1756.2018.10.024.
3 中国医师协会新生儿科医师分会循证专业委员会. 新生儿经外周置入中心静脉导管操作及管理指南(2021)[J]. 中国当代儿科杂志, 2021, 23(3): 201-212. PMID: 33691911. PMCID: PMC7969181. DOI: 10.7499/j.issn.1008-8830.2101087.
4 Ares G, Hunter CJ. Central venous access in children: indications, devices, and risks[J]. Curr Opin Pediatr, 2017, 29(3): 340-346. PMID: 28323667. DOI: 10.1097/MOP.0000000000000485.
5 凌其英, 陈虹, 唐敏, 等. 心电监护仪在新生儿PICC置管中的定位效果[J]. 中国当代儿科杂志, 2018, 20(5): 363-367. PMID: 29764571. PMCID: PMC7389060. DOI: 10.7499/j.issn.1008-8830.2018.05.005.
6 Xiao AQ, Sun J, Zhu LH, et al. Effectiveness of intracavitary electrocardiogram-guided peripherally inserted central catheter tip placement in premature infants: a multicentre pre-post intervention study[J]. Eur J Pediatr, 2020, 179(3): 439-446. PMID: 31788740. DOI: 10.1007/s00431-019-03524-3.
7 王燕, 姜琳. 两种体外测量方法在新生儿下肢外周静脉穿刺中心静脉置管中的比较[J]. 解放军护理杂志, 2019, 36(1): 84-86, 90. DOI: 10.3969/j.issn.1008-9993.2019.01.00.
8 周莲娟, 徐红贞, 徐美芳, 等. 新生儿下肢静脉PICC头端心电图定位方法的临床应用[J]. 中国实用护理杂志, 2017, 33(16): 1246-1249. DOI: 10.3760/cma.j.issn.1672-7088.2017.16.012.
9 Gorski LA. The 2016 infusion therapy standards of practice[J]. Home Healthc Now, 2017, 35 (1):10-18. PMID: 27922994. DOI: 10.1097/NHH.0000000000000481.
10 陈秀文, 周乐山, 谭彦娟, 等. 新生儿上肢静脉与下肢静脉PICC置管 效果比较的Meta分析[J]. 中国当代儿科杂志, 2019, 21(12): 1164-1171. PMID: 31874653. PMCID: PMC7389005. DOI: 10.7499/j.issn.1008-8830.2019.12.003.
11 肖艾青, 张榕, 凃满梅, 等. 不同路径经外周静脉置入中心静脉导管在早产儿治疗中的应用[J]. 解放军护理杂志, 2016, 33(17): 23-25. DOI: 10.3969/j.issn.1008-9993.2016.17.006.
12 付贞艳, 权明桃, 陈开永, 等. 新生儿不同静脉置入PICC效果的Meta分析[J]. 护士进修杂志, 2020, 35(3): 218-225. DOI: 10.16821/j.cnki.hsjx.2020.03.006.
13 周秀莲, 付佳慧, 付晓辉, 等. 不同孕周、体重新生儿PICC最佳导管尖端位置与胸椎的相关性分析[J]. 齐鲁护理杂志, 2020, 26(3): 86-88. DOI: 10.3969/j.issn.1006-7256.2020.03.027.
14 刘丹妮, 姜红, 刘红梅, 等. PICC定位技术——心房内心电导联确定新生儿PICC导管尖端位置的应用[J]. 中国小儿急救医学, 2015, 22(12): 869-871. DOI: 10.3760/cma.j.issn.1673-4912.2015.12.015.
基金
四川省人民医院专项基金（2021ZX04）；四川大学出生缺陷与相关妇儿疾病教育部重点实验室开放课题（2020KF04）；四川省护理学会课题（H20047）。
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