本文選題：經(jīng)外周靜脈植入中心靜脈導(dǎo)管 + 心電圖定位　； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的利用篩檢試驗(yàn)的方法對(duì)心電圖技術(shù)定位三向瓣膜PICC導(dǎo)管尖端位置的準(zhǔn)確性以及心電圖定位技術(shù)的臨床應(yīng)用潛力進(jìn)行全面系統(tǒng)的評(píng)價(jià),同時(shí)探討心電圖技術(shù)在定位房顫患者PICC導(dǎo)管尖端位置的應(yīng)用效果。方法首先選取青島大學(xué)附屬醫(yī)院符合納入標(biāo)準(zhǔn)的170例患者,采用自身對(duì)照研究將研究對(duì)象使用心電圖定位的PICC導(dǎo)管尖端位置與置管結(jié)束后拍的X線(xiàn)片進(jìn)行比較,應(yīng)用篩檢試驗(yàn)的方法對(duì)其進(jìn)行評(píng)價(jià),分別計(jì)算其真實(shí)性指標(biāo)、可靠性指標(biāo)以及實(shí)用性指標(biāo),并計(jì)算心電圖P波的高度和P/R比值的平均數(shù)及其95%的置信區(qū)間,從而對(duì)導(dǎo)管尖端位置的準(zhǔn)確性以及心電圖定位技術(shù)的臨床應(yīng)用潛力作出較準(zhǔn)確全面的判斷。然后選取青島大學(xué)附屬醫(yī)院符合納入標(biāo)準(zhǔn)的56例需行PICC置管的房顫患者,采用自身對(duì)照研究的方法將心電圖定位的PICC導(dǎo)管尖端位置與研究對(duì)象置管后拍攝的X片進(jìn)行比較,計(jì)算其靈敏度、特異度及c2值,同時(shí)計(jì)算f、f′、(f′-f)/f比值及(f′-f)/f的95%置信區(qū)間,以觀察心電圖定位技術(shù)在房顫患者中的應(yīng)用效果。結(jié)果1.利用篩檢試驗(yàn)對(duì)心電圖技術(shù)定位三向瓣膜PICC導(dǎo)管尖端位置的準(zhǔn)確性及臨床應(yīng)用潛力進(jìn)行評(píng)價(jià),其真實(shí)性指標(biāo)中靈敏度98.43%;特異度91.18%,約登指數(shù)0.90,假陰性率1.57%,假陽(yáng)性率8.82%,粗符合率為96.89%,陽(yáng)性似然比11.16,陰性似然比0.02,實(shí)用性指標(biāo)中陽(yáng)性預(yù)測(cè)值為97.66%,陰性預(yù)測(cè)值為93.94%,可靠性指標(biāo)中Kappa指數(shù)值為0.91,可以看出心電圖定位技術(shù)的真實(shí)性指標(biāo)、可靠性指標(biāo)、實(shí)用性指標(biāo)均較好。2.對(duì)留取的心電圖P波進(jìn)行量化,測(cè)得P波高度為0.92±0.37cm,95%置信區(qū)間為(0.84 0.99),P/R比值為0.78±0.45cm,95%置信區(qū)間為(0.69 0.87),為使用心電圖定位時(shí)對(duì)P波的判斷提供相對(duì)客觀的依據(jù)。3.利用心電圖技術(shù)定位房顫患者PICC導(dǎo)管尖端位置,其c2值為0,P0.05差異無(wú)統(tǒng)計(jì)學(xué)意義,因此利用心電圖技術(shù)定位房顫患者PICC導(dǎo)管尖端位置與使用X線(xiàn)定位差異無(wú)統(tǒng)計(jì)學(xué)意義。4.利用心電圖技術(shù)定位房顫患者PICC導(dǎo)管尖端位置,計(jì)算其靈敏度、特異度,得其靈敏度93.75%,特異度100%,因此利用心電圖技術(shù)定位房顫患者PICC導(dǎo)管尖端位置的準(zhǔn)確性較高且不易發(fā)生異位。5.對(duì)留取的房顫波形進(jìn)行量化,得到f波高度為(1.06±0.25)cm、f′波高度為(1.68±0.34)cm、(f′-f)/f的95%置信區(qū)間為(0.52,0.69),為今后房顫患者導(dǎo)管尖端定位提供一個(gè)相對(duì)客觀的依據(jù)。結(jié)論心電圖技術(shù)可以較精確的定位三向瓣膜PICC導(dǎo)管的尖端位置,其可靠性和實(shí)用性較高,臨床應(yīng)用潛力較大,值得在臨床推廣應(yīng)用。同時(shí)該研究探討了心電圖定位技術(shù)在房顫患者中的應(yīng)用效果,該研究發(fā)現(xiàn)利用心電圖定位技術(shù)可以定位房顫患者PICC導(dǎo)管尖端位置,通過(guò)對(duì)置管過(guò)程中房顫波形變化的判斷定位導(dǎo)管尖端的位置,且準(zhǔn)確率較高,但由于樣本例數(shù)較少,還需要進(jìn)一步探索研究。
[Abstract]:Objective to evaluate the accuracy of electrocardiogram (ECG) technique in locating the tip position of three-way valve PICC catheter and the clinical application potential of electrocardiogram (ECG) localization. At the same time, the effect of electrocardiogram (ECG) in locating the tip position of PICC catheter in patients with atrial fibrillation was discussed. Methods at first, 170 patients who met the inclusion criteria in Qingdao University affiliated Hospital were selected and compared with X-ray films taken after catheter placement by electrocardiogram (ECG). The method of screening test was used to evaluate it, and its authenticity index, reliability index and practicability index were calculated, and the height of P wave and the average of P / R ratio and its 95% confidence interval were calculated. The accuracy of catheter tip position and the clinical application potential of electrocardiogram localization technology are judged accurately and comprehensively. Then 56 patients with atrial fibrillation who needed PICC catheterization were selected from Qingdao University affiliated Hospital. The PICC catheter tip position was compared with the X ray taken by the subjects after catheterization by electrocardiogram (ECG). The sensitivity, specificity and c2 value were calculated. The ratio of fen / f / f and the 95% confidence interval of F / F / f were calculated to observe the effect of electrocardiogram (ECG) localization in patients with atrial fibrillation (AF). Result 1. The accuracy and clinical application potential of electrocardiogram (ECG) technique in locating the tip position of three-way valve PICC catheter were evaluated by screening test. The sensitivity is 98.433.The specificity is 91.18, the Yorden index is 0.90, the false negative rate is 1.57, the false positive rate is 8.82, the crude coincidence rate is 96.89, the positive likelihood ratio is 11.16, the negative likelihood ratio is 0.02, the positive predictive value is 97.66, the negative predictive value is 93.94, the reliability is reliable. The value of Kappa index in sex index is 0.91. it can be seen that the true index of electrocardiogram localization technology. Reliability index and practicability index are all good. 2. 2. The measured P wave height was 0.92 鹵0.37 cm ~ (-1) 95% confidence interval was 0.84 0.99 cm ~ (-1) P / R ratio 0.78 鹵0.45 cm ~ (-1) 95% confidence interval was 0.69 0.87%, which provided a relatively objective basis for the judgement of P wave when using electrocardiogram. There was no significant difference in PICC catheter tip position between atrial fibrillation patients using electrocardiogram (ECG) technique, and the c2 value was 0 (P 0.05). Therefore, there was no significant difference between electrocardiogram technique and X ray location in atrial fibrillation patients with PICC catheter tip location. 4. Electrocardiogram (ECG) technique was used to locate the tip position of PICC catheter in patients with atrial fibrillation and to calculate its sensitivity and specificity. Its sensitivity 93.75 and specificity 100, so the use of electrocardiogram to locate atrial fibrillation patients PICC catheter tip position accuracy is high and not prone to ectopic .5. The f wave height is 1.06 鹵0.25 cm / 'and the 95% confidence interval of f wave height is 1.68 鹵0.34 cm / f = 0.52 ~ 0.69 / f, which provides a relatively objective basis for the location of catheter tip in patients with atrial fibrillation. Conclusion the electrocardiogram technique can accurately locate the tip position of the three-way valve PICC catheter, its reliability and practicability are high, and the clinical application potential is great, so it is worth popularizing in clinic. At the same time, the effect of electrocardiogram (ECG) localization in patients with atrial fibrillation was discussed. It was found that electrocardiographic localization could locate the tip of PICC catheter in patients with atrial fibrillation. The location of catheter tip is determined by contrasting the changes of atrial fibrillation waveforms, and the accuracy is high. However, due to the small number of samples, further research is needed.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R472

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