摘要
目的探讨腔内心电图(IC-ECG)实时导航技术与传统X线在上臂植入式输液港尖端定位中的应用效果比较,分析IC-ECG对乳腺癌化疗患者导管相关并发症的预防作用。方法采用前瞻性随机对照研究,纳入2022年2月—2025年3月需行上臂植入式输液港置入的乳腺癌化疗患者240例,按区组随机法分为IC-ECG组(n=120)与X线组(n=120)。X线组采用超声引导联合体表测量(胸锁关节至第三肋间距离法)预估导管长度,经X线透视确认尖端位置,由医生在上臂皮下埋入输液港;IC-ECG组通过实时监测P波形态变化(P波增幅且P/R比值稳定于50%~80%为导管尖端到位标准),实现动态导航确认定位导管尖端位置,由医生在上臂皮下埋入输液港。比较两组导管尖端一次到位率、操作效率(导管置入操作耗时)及安全性指标(并发症、操作性疼痛)。结果IC-ECG组呈现显著优势:①精准性:导管尖端一次到位率IC-ECG组优于X线组(99.16%vs.85.83%,χ^(2)=13.330,P<0.01);②操作效率:导管置入操作耗时IC-ECG组较X线组缩短(44.28±5.92 min vs.64.39±8.76 min,t=20.840,P<0.01);③安全性:并发症发生率IC-ECG组低于X线组(6.67%vs.16.67%,χ^(2)=5.822,P<0.05);术后24 h疼痛评分(NRS)IC-ECG组低于X线组(2.30±0.80 vs.3.80±1.10,t=9.443,P<0.01)。结论IC-ECG技术通过生物电阻抗原理实现导管尖端实时动态导航,较传统X线定位可显著提高乳腺癌患者上臂植入式输液港置管精准性,降低血栓等并发症风险,同时提升护理操作效率及患者舒适度,为化疗静脉通路管理提供创新性解决方案。
Objective To compare the effect between intracavitary electrocardiogram(ICECG)and X-rays in tip location of implantable infusion port in the upper arm,and to analyze the value of IC-ECG in prevention of catheter-related complication among breast cancer patients un⁃dergoing chemotherapy.Methods A total of 240 breast cancer patients who required placement of implantable infusion port in the upper arm were divided into the IC-ECG group(n=120)and Xrays group(n=120)by using block randomization.In the control group,an ultrasound-assisted anatomy measurement(Rountree extracorporeal measurement)was used to predict length from the puncture point to the right sternoclavicular joint and back down to the third intercostal space,and the tip location was verified by using X-rays.In the IC-ECG group,a real-time monitoring of the changes in P wave morphology by IC-ECG was adopted,and different changes in P wave indi⁃cated different positioning of the catheter tip.The accuracy of catheter tip location at first time of placement,operation efficacy(time spent in catheter placement)and safety indexes(complica⁃tions and procedural pain)were measure and compared between two groups.Results IC-ECG showed advantages as follows:①Accuracy:The rate of accurate catheter tip location at first time of placement in the IC-ECG group was higher than that in the control group(99.16%vs.85.83%,χ^(2)=13.330,P<0.01).②Efficacy:A shorter time spent in catheter placement was ob⁃served in the IC-ECG group than that in the control group(44.28±5.92 min vs.64.39±8.76 min,t=20.840,P<0.01).③Safety:The incidence of catheter-related complications in the IC-ECG group was lower than that in the control group(6.67%vs.16.67%,χ^(2)=5.822,P<0.05).Postoperative 24-h NRS score in the IC-ECG group was lower than that in the control group(2.30±0.80 vs.3.80±1.10,t=9.443,P<0.001).Conclusion The IC-ECG localization tech⁃niques helps to increase accuracy of catheter tip location in implantable infusion port placement in the upper arm,reduce the risk of thrombosis and other complications,and improve the efficiency of nursing operations and patient comfort.
作者
房蓓蓓
FANG Beibei(Department of Breast Surgery,Jiangsu Province Hospital of Chinese Medicine,Nanjing,Jiangsu,210029)
出处
《中西医结合护理》
2025年第9期7-12,共6页
Chinese Journal of Integrative Nursing
关键词
腔内心电图
上臂植入式输液港
导管尖端精准定位
导管相关性并发症
乳腺癌
化疗
intracavitary electrocardiogram
implantable infusion port in the upper arm
accurate location of catheter tip
catheter-related complications
breast cancer
chemotherapy
