f波与QRS波振幅比值在房颤患者PICC尖端定位中的应用研究

doi:10.3761/j.issn.0254-1769.2025.13.003

摘要/Abstract

摘要：

目的探讨f波与QRS波振幅的比值（以下简称f/R值）在房颤患者心腔内电图PICC尖端定位中的应用效果，以指导临床实践。方法采用便利抽样法，选取2023年7月—2024年7月苏州市某三级甲等医院收治的房颤患者作为研究对象。在PICC置管过程中，连接心腔内电图并观察f波及QRS波振幅变化，置管成功后测量f/R值，并通过胸部X线确定导管尖端位置。比较不同范围f/R值对应的PICC尖端位置准确率，并收集心律失常发生率。绘制受试者操作特征曲线，分析f/R值在PICC尖端定位中的诊断价值。结果共纳入68例房颤患者，f/R值为20.63%~91.24%。不同范围f/R值对应的PICC尖端位置准确率比较，差异具有统计学意义（P=0.006）。f/R值在PICC尖端定位中的受试者操作特征曲线下面积为0.784（P=0.009）、Youden指数最大值为0.567、最佳诊断临界值为40.00%、灵敏度为81.7%、特异度为75.0%、阳性预测值为96.1%、阴性预测值为35.3%。置管过程中，所有患者均未发生除房颤外的心律失常。结论通过f/R值定位PICC尖端位置具有准确性和安全性，f/R值≥40%时判断PICC尖端位于理想位置的准确率较高。

关键词: 心房颤动, 心腔内电图, 经外周静脉穿刺中心静脉导管, 尖端定位, 护理

Abstract:

Objective To evaluate the clinical utility of the f-wave to QRS complex amplitude ratio（f/R ratio） in intracardiac electrogram（IC-ECG）-guided positioning of peripherally inserted central catheter（PICC） tips in patients with atrial fibrillation（AF），providing evidence to enhance clinical practice. Methods This study employed a convenience sampling method to enroll eligible AF patients admitted to a tertiary hospital in Suzhou from July 2023 to July 2024. During PICC placement，IC-ECG was utilized to monitor f-wave and QRS complex amplitude variations. Following successful catheterization，the f/R ratio was measured，and chest X-ray was performed to confirm the catheter tip position. The accuracy of PICC tip positioning across different f/R ratio ranges was analyzed，and the incidence of arrhythmias was recorded. A receiver operating characteristic curve was constructed to assess the diagnostic performance of the f/R ratio in PICC tip localization. Results A total of 68 AF patients were included，with f/R ratios ranging from 20.63% to 91.24%. PICC tip positioning accuracy varied significantly across different f/R ratio ranges（P=0.006）. The area under the ROC curve（AUC） for f/R ratio in PICC tip positioning was 0.784（P=0.009），with a maximum Youden index of 0.567，an optimal diagnostic threshold of 40.00%，a sensitivity of 81.7%，a specificity of 75.0%，a positive predictive value of 96.1%，and a negative predictive value of 35.3%. No arrhythmias other than AF occurred during the procedure. Conclusion The f/R ratio provides reliable and safe guidance for PICC tip positioning in AF patients. An f/R ratio≥40% is associated with higher accuracy in identifying the optimal catheter tip position.

Key words: Atrial Fibrillation, Intracardiac Electrogram, Peripherally Inserted Central Catheter, Tip Positioning, Nursing Care

施丽华, 杨荣荣, 廖丽红, 郭菁, 孙秋, 贡源源, 叶加宝, 张建芳. f波与QRS波振幅比值在房颤患者PICC尖端定位中的应用研究[J]. 中华护理杂志, 2025, 60(13): 1553-1557.

SHI Lihua, YANG Rongrong, LIAO Lihong, GUO Jing, SUN Qiu, GONG Yuanyuan, YE Jiabao, ZHANG Jianfang. Application of f-wave to QRS complex amplitude ratio in PICC tip positioning for patients with atrial fibrillation[J]. Chinese Journal of Nursing, 2025, 60(13): 1553-1557.

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