摘要
目的：评价心内心电图技术监测锁骨下静脉穿刺时中心静脉导管位置的可行性。方法：选择80例拟行中心静脉置管的择期手术全麻成年患者，随机均分为A、B两组（n=40），均于右锁骨下切迹下方1.0～1．5cm处行右锁骨下静脉穿刺。A组穿刺后，计算中心静脉导管的留置深度（L）=（H／10）-2（H为身高，L、H单位为cm）；B组依据心内心电图P波特征表现．确定中心静脉导管置管深度。术毕均经常规床旁x线正位胸片检查确定导管位置，以中心静脉导管尖端位于第3，4胸椎为导管到位标准，记录两组的到位情况并计算到位率。结果：A、B两组置管深度分别为（15．1±1．2）cm，（13．4±0，9）cm，差异具有显著意义（P〈0．05）；导管到位率分别为80％和100％，差异也具有显著性意义（P〈0．05）。结论：应用心内心电图引导技术辅助置管，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，此方法操作简单易行、安全有效，值得临床推广使用。
Objective：To evaluate the possibility of IVECG as 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 under general anesthesia were randomly divided into two groups, with 40 cases in each group. Patients all received fight subclavian vein catheterization through the supraclaricular approach below right subclavian thyroid notch 1.0-1.5 cm. Patients in Group A received routine method,the depth of the catheter（L） = （H/10） -2;Patients in Group B adjusted 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 80% and 100% respectively. There were obvious statistical significance between the two groups （P 〈 0.05）. Conclusion： Application of the catheter based on the characters of IVECG can monitor the variation of the depth of the catheter and also provide valuable information about the catheter that fails to be placed into the superior vena tara. It also can reduce costs associated with repositioning procedures. The technique is easy and safe to apply and should be widely used.
出处
《临床误诊误治》
2007年第10期28-30,共3页
Clinical Misdiagnosis & Mistherapy
基金
河北省科学技术与发展指导计划课题(编号06276160)
