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心内心电图辅助右锁骨下静脉穿刺导管定位的临床观察
Intracardiac Electrocardiography-guided Cannulation of Right Subclavian Vein
【摘要】 目的:利用中心静脉 穿刺的导引钢丝作心内电极,以心电波形变化指导中心静脉导管定位。方法:32例病例,由锁骨下进路穿刺右锁骨下静脉。穿刺进入血管后将导引钢丝代替肢体导联的右上电极与监护仪相连,观察钢丝J形端拾取的心电波形。结果:30例病人立即出现P波变尖和振幅加大等特征性变化;平均置管深度10.13cm时P波开始变尖,至16.36cm振幅最高,甚至超过R波。此后逐渐降低,可有双相或倒置。1例心房颤动病人表现为f波振幅加大。另1例穿刺后无P波变化者胸片示导管入右颈内静脉,重新置管见特征性P波后,重拍胸片证实导管进入上腔静脉。结论:通过导引钢丝引出的特征性P波变化判断静脉导管尖端的部位,是一种简便、实用和可靠的定位方法。
【Abstract】 Objective: To assess the lo-cation of the central venous catheter by intrac-ardiac electrocardiography when the J -tip of guide wire is used as an exploring electrode. Methods: The central venous catheters were percutaneously inserted via the right subciavian vein in 32 patients. As the guide wire and the catheter entered the vein, the outside tip of the guide wire was connected to an electrocardio-graphic unit and the intracardiac elecatrocar-diography obtained from J -tip of the guide wire could be observed. Results: Largo ampli-tude upward P wave was occurred in 30 pa-tients during the cannulation. The P wave be-came larger when the mean length of the cannulation was 10. 13 cm and the highest voltage was observed when the catheters advanced at 16. 36 cm, even higher than R wave . Then it became lower, biphasic or inverted . A larger "f" wave was present in a patient with atrial fibrillation during the cannulation. Another patient didn’t show any change in P wave during insertion and chest radiograph showed that the catheter passed upvvard into the right internal jugular vein. After withdrawing and replacing the catheter, a typical P wave change was demonstrated and chest X -ray confirmed that the tip of the catheter was in the superior vena cava. Conclusions: It is a practicai and reliable technique to ensure the placement of the catheter by intracardiac electrocardiography.
【Key words】 catheterization; subciavian vein; intracardiac electrocardiography;
- 【文献出处】 当代医学 ,China Comtemporary Medicine , 编辑部邮箱 ,2000年07期
- 【分类号】R401
- 【下载频次】73