摘要
目的X射线定位法被视为静脉导管头端定位的"金标准",但存在辐射暴露的弊端。国内外均有借助心电图引导进行静脉导管头端定位的研究,但在手臂港应用未见报道。本研究探讨心电图引导在手臂输液港静脉导管头端精准定位的临床应用。方法2018-09-01-2018-12-31南京医科大学第一附属医院乳腺病科收治的111例植入手臂输液港女性乳腺癌化疗患者为研究对象。采用心电图引导手臂输液港导管头端定位,通过观察心电图上P波变化全程追踪手臂输液港导管置入情况,判断导管头端的位置及确认导管最终置入长度。手臂输液港置入后胸片定位,直观导管与上腔静脉的关系,通过关联分析评价影响心电导联精准性的相关因素。结果心电图引导手臂输液港导管头端定位精准性为73.87%,95%CI:64.68~81.75。其影响因素为患者身高(OR=1.18,95%CI:1.06~3.04)及穿刺点至右胸锁关节的长度(OR=1.32,95%CI:1.06~1.63)。患者身高和穿刺点至右胸锁关节的长度呈低度正相关,r=0.27,P=0.004。在穿刺长度11.53cm的平均基础上,身高每增加1cm,穿刺长度平均增加0.12cm(r=0.2716,P=0.004)。此外,纳入身高信息的模型准确定位效果较好(AUC=0.7098,95%CI:0.5951~0.8246)。结论临床操作考虑患者身高有助于心电图引导手臂输液港导管头端精准定位。
OBJECTIVE X-ray localization is regarded as the"gold standard"for the localization of the head end of venous catheter,but it has the disadvantage of radiation exposure.In China and abroad,the head end localization of venous catheter has been studied with the help of electrocardiogram guidance,but it has not been reported in the arm port.This study discusses the clinical application of electrocardiogram guidance in the accurate localization of venous catheter head end in arm port.METHODS Totally 111 breast cancer patients admitted to the arm port were enrolled from the First Affiliated Hospital of Nanjing Medical University from 2018-09-01 to 2018-12-31.By fixing the position of the head of the catheter in the port of the infusion port guided by the electrocardiogram and observing the position of the catheter infusion port tracked by observing the change of the P wave on the electrocardiogram,simultaneously,combining the position of the catheter tip determined,the final length of the catheter was confirmed and the chest X-ray was taken after the arm infusion port was placed,the relationship between the intuitive catheter and the superior vena cava is analyzed to determine the factors that influence the accuracy of the ECG lead.RESULTS The accuracy of the positioning of the head of the electrocardiogram guiding arm infusion port was 73.87%,95%CI:64.68-81.75.The influencing factors were height(OR=1.18,95%CI:1.06-3.04)and length of puncture point to right sternocleidal joint(OR=1.32,95%CI:1.06-1.63).There was a positive correlation between patient height and puncture point to the length of the right sternocleidal joint(r=0.2716,P=0.004).On the average of the puncture length of 11.53 cm,for every 1 cm increasing in height,the puncture length increased by an average of 0.12 cm.The prediction model utilizing height information achieved a moderate accuracy of the positioning(AUC=0.7098,95%CI:0.5951-0.8246).CONCLUSION The clinical operation incorporating height information of patients benefits the accurate positioning of the catheter head of the arm port.
作者
徐海萍
汪静雯
丁晓慧
王水
张汝阳
XU Hai-ping;WANG Jing-wen;DING Xiao-hui;WANG Shui;ZHANGRu-yang(Department of Breast Surgery,First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,P.R.China;Department of Biostatistics,Center for Global Health,School of Public Health,Nanjing Medical University,Nanjing 211166,P.R.China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2019年第23期1800-1804,共5页
Chinese Journal of Cancer Prevention and Treatment
基金
江苏省高等学校自然科学研究面上项目（18KJB310011）
江苏省妇幼健康科研项目（F201821）
关键词
心电图
手臂输液港
导管头端
定位精准性
相关因素
electrocardiogram
arm port
catheter tip
positioning accuracy
related factors
