CAJ | 학술논문

目的：探讨在应用Peres’定位法的基础上结合使用心房内心电图，在经颈内静脉行中心静脉置管术中定位导管尖端位置中的临床应用价值。方法2013年1月－2014年1月，共1980例接受颈内静脉置管的成年肿瘤患者（18～88岁）参与研究，共有61例失访。最终1919例患者进入研究，按随机实验法，分为实验组980例，对照组939例。实验组在Peres’公式定位基础上术中使用心房内心电图技术行导管定位，对照组仅使用Peres’定位法进行置管长度预估，通过胸部正位X线了解导管尖端到位情况。结果 Peres’定位结合心房内心电图与单纯使用Peres’定位法两种方法导管尖端到位率分别为99．6％和98．5％；两组最终置管长度差异无统计学意义（P＞0．05）；但使用心房内心电图组导管异位率低于单纯Peres’定位组（ P＜0．05）；心房内心电图组在上腔静脉内的导管X线投影深度较Peres’定位组浅（ P＜0．05）。结论在Peres’定位法基础上术中加用心房内心电图引导技术，可在术中及时发现异位，减少导管异位率，保证置管准确性和安全性。在颈内静脉置管中使用心电图技术，建议以体表定位为参考做适当调整，不建议单独以心电图波形变化决定导管置入长度。
목적：탐토재응용Peres’정위법적기출상결합사용심방내심전도，재경경내정맥행중심정맥치관술중정위도관첨단위치중적림상응용개치。방법2013년1월－2014년1월，공1980례접수경내정맥치관적성년종류환자（18～88세）삼여연구，공유61례실방。최종1919례환자진입연구，안수궤실험법，분위실험조980례，대조조939례。실험조재Peres’공식정위기출상술중사용심방내심전도기술행도관정위，대조조부사용Peres’정위법진행치관장도예고，통과흉부정위X선료해도관첨단도위정황。결과 Peres’정위결합심방내심전도여단순사용Peres’정위법량충방법도관첨단도위솔분별위99．6％화98．5％；량조최종치관장도차이무통계학의의（P＞0．05）；단사용심방내심전도조도관이위솔저우단순Peres’정위조（ P＜0．05）；심방내심전도조재상강정맥내적도관X선투영심도교Peres’정위조천（ P＜0．05）。결론재Peres’정위법기출상술중가용심방내심전도인도기술，가재술중급시발현이위，감소도관이위솔，보증치관준학성화안전성。재경내정맥치관중사용심전도기술，건의이체표정위위삼고주괄당조정，불건의단독이심전도파형변화결정도관치입장도。
Objective To study the clinical value of intra‐trial electrocardiogram (ECG) during the internal jugu‐lar vein cauterization .Method 1980 cancer patients aged 18‐60 years from Feb .2013 to Feb .2014 were selected for internal jugular vein (IJV) catheterization ,with the loss of 61 cases .In the experiment group ,central venous cathe‐terization was done by the Peres’ formula and ECG guidance .For patients in control group ,the catheter was insert‐ed blindly using Peres’ formula .The position of the tip of central venous catheter was confirmed by postoperative chest X‐ray at upright position .Result 99 .6% of patients in the experiment group had correct positioning of catheter tip ,while in the control group the proportion was 98 .5% .There was no significance difference between the two groups in the insertion depth of catheters .“Peres’ formula+intra‐trial ECG”group had lower mal‐position rate than“Peres’ formula” group (P< 0 .05) .The tips of catheters in the superior vena cava by X‐ray of the experiment group were shallower than the control group .Conclusion Intra‐trial ECG technique could upgrade the accuracy and security of internal jugular vein catheterization .We were against insertion depth of catheters decided only by Intra‐trial ECG technology .Intra‐trial ECG technique was recommended combining with Peres’ formula .