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目的：探讨心电图特征性 P 波在 PICC 置管中尖端定位的效果。方法将2013年11月—2015年1月136例需要置入PICC的患者按照随机数字表法随机分为研究组与对照组各68例。研究组在PICC穿刺成功送管至右胸锁关节时连接心电监护仪,根据心电图上P波的变化确定导管末端的最佳位置。对照组常规PICC穿刺成功送导管至预测位置后,对患者进行X线拍片定位至理想位置。观察统计两种定位方法的准确率、时间、费用、预测长度与实际置入长度和患者一般资料。结果研究组患者定位准确率为94.1%,与对照组比较差异无统计学意义(χ2=2.318,P>0.05)；研究组所需时间为(3.16±1.57)min,费用为(7.12±0.56)元,与对照组比较差异有统计学意义(t 值分别为8.819,27.336；P<0.05)。两组患者一般资料、置管预测长度与实际置入长度比较差异均无统计学意义( P>0.05)。结论心电定位法省时、费用低,护患双方均避免了定位中X线辐射的伤害,可作为PICC置管定位的又一方法应用于临床。

Objective To explore the comparative effects of the application of ECG characteristic P-wave in PICC tip alignment. Methods Totals of 136 patients who needed PICC intubation were randomly divided into the experimental group and the control group, with 68 cases in each group. In the experimental group,after the PICC was successfully delivered to the right sternoclavicular joint, the ECG monitor was connected and based on the changes of P-wave on ECG to determine the optimum position of the end of catheter. In the control group,after the PICC was successfully delivered tothe predictive position, patients were sent to the Radiology Department to receive X-ray and located to the optimum position. The alignment accuracy rate, intervention time, costs, the predictive position and practical position, and general information were compared. Results The alignment accuracy rate in the experimental group was 94. 1%, which had no significant difference (χ2 =2. 318,P>0. 05). The intervention time and cost of the experimental group were (3. 16 ± 1.57) min and (7.12 ±0.56) yuan, which were significantly different from those in the control group (t=8. 819,27. 336;P < 0. 05 ). The results of general information and the predictive position and practical positionhad no significant difference (P>0. 05). Conclusions ECG alignment is accurate, time-saving and with low costs and it can avoid the radiation harm for nurses and patients in X-ray alignment. ECG alignment can replace the traditional X-ray alignment and become another alignment method for PICC intubation in clinical application.