在院前急救过程中，心电图引导是否是正确放置中心静脉导管的一种有用方法？
Is ECG-guidance a helpful method to correctly position a central venous catheter during prehospital emergency care?
作者信息
David J S, Tazarourte K, Perfus J P, Savary D
机构信息
Department of Anaesthesiology, Critical Care and Emergency Medical System, Edouard Herriot Hospital, Hospices Civils de Lyon and Claude Bernard University, Lyon, France.
出版信息
Acta Anaesthesiol Scand. 2005 Aug;49(7):1010-4. doi: 10.1111/j.1399-6576.2005.00762.x.
BACKGROUND
Insertion of a central venous catheter (CVC) in an emergency situation is challenging and may be potentially associated with more complications. Because CVC positioning by ECG-guidance may help to decrease the frequency of a malpositioned catheter, we decided to prospectively evaluate the usefulness of positioning a CVC by ECG-guidance during prehospital emergency care.
METHODS
Prospective observational study during which all patients requiring CVC placement during prehospital care were included. We compared two periods of 1 year during which CVCs were inserted without and then with the help of ECG-guidance.
RESULTS
Eighty successive patients were included. We observed a significant reduction of incorrectly positioned CVCs with ECG-guidance (13% vs. 38%, P < 0.05) and a decreased number of chest X-rays needed to verify the position of the CVC (40 vs. 54, P < 0.05).
CONCLUSION
ECG-guidance is a safe and feasible technique which significantly improved the rate of CVCs correctly positioned during prehospital emergency care.
背景
在紧急情况下插入中心静脉导管（CVC）具有挑战性，并且可能潜在地与更多并发症相关。由于通过心电图引导进行CVC定位可能有助于降低导管位置不当的频率，我们决定前瞻性地评估在院前急救期间通过心电图引导进行CVC定位的有效性。
方法
前瞻性观察性研究，纳入所有在院前护理期间需要放置CVC的患者。我们比较了两个为期1年的时间段，在第一个时间段内不借助心电图引导插入CVC，在第二个时间段内借助心电图引导插入CVC。
结果
连续纳入80例患者。我们观察到在心电图引导下CVC位置不当的情况显著减少（13%对38%，P<0.05），并且验证CVC位置所需的胸部X光片数量减少（40张对54张，P<0.05）。
结论
心电图引导是一种安全可行的技术，可显著提高院前急救期间CVC正确定位的率。
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