掌上超声定位在桡动脉穿刺置管中的临床应用

Clinical application of pocket-sized ultrasound localization on radial artery cannulation

中文关键词: 掌上超声  超声检查  桡动脉  导管插入术  外周

英文关键词: Pocket-sized ultrasound  Ultrasonography  Radial artery  Catheterization  Peripheral

中文摘要:

      目的 评价掌上超声定位在桡动脉穿刺置管中的临床应用效果。方法 择期手术拟行桡动脉穿刺置管术的患者210例, 男146例, 女64例, 年龄18～70岁, ASA Ⅰ～Ⅲ级。按随机数字表法将患者分为三组,每组70例: 触摸组(C组), 使用传统触摸法定位桡动脉进行穿刺置管;掌上超声组(U1组), 使用GE Vscan掌上超声定位桡动脉短轴平面外法进行穿刺置管;普通超声组(U2组), 使用普通便携式超声定位桡动脉短轴平面外法进行穿刺置管。所有患者穿刺前均行超声检查, 测量并记录桡动脉的直径及桡动脉前壁距皮肤表面的垂直距离（深度）;记录首次穿刺成功、穿刺次数≤3次的例数、穿刺次数、穿刺时间和穿刺部位血肿的发生情况。结果 三组桡动脉直径、深度差异均无统计学意义。与C组比较, U1组和U2组首次穿刺成功率和穿刺次数≤3次的比例明显升高, 穿刺次数明显减少, 穿刺时间明显缩短, 穿刺血肿发生率明显降低(P＜0.05);U1组与U2组上述各指标差异均无统计学意义。结论 超声是桡动脉穿刺置管中一种极有价值的辅助手段, 同时掌上超声可作为普通超声的良好替代选择。

英文摘要:

      Objective To assess the clinical application effect of pocket-sized ultrasound-guided radial artery cannulation. Methods Two hundreds and ten patients undergoing elective surgery, 146 males and 64 females, aged 18-70 years, ASA physical status Ⅰ-Ⅲ, were scheduled for radial arterial catheterization. The patients were randomly divided into three groups (n=70 each): control group (group C), pocket-sized ultrasound group (group U1) and conventional portable ultrasound group (group U2). In group C, the radial artery catheter placement were performed by traditional palpation method. In group U1, the radial artery cannulation were achieved by GE Vsacn pocket-sized ultrasound guidance. In groups U2, the ultrasound-guided radial artery catheterization were completed by conventional portable ultrasound. Before radial arterial cannulation, the diameter of radial artery and the distance between skin to artery in ultrasound images were measured and recorded. The first attempt success rate, cases that punctured less than 3 times, the number of attempts, successful cannulation time and potential complications were recorded. Results There was no statistic significant difference in the hemodynamic parameters, the diameter and the depth of radial artery among three groups. Compared with group C, patients in the other groups had higher first attempt success rate and greater proportion of cases that punctured less than 3 times, fewer placement attempts, shorter catheterization time, and lower incidence of the complication of hematoma (P＜0.05). There was no significant difference between groups U1 and U2 among these characteristics. Conclusion Ultrasound is a valuable adjunct to radial arterial catheter insertion. The pocket-sized ultrasound may be a good alternative option to guide radial artery catheter placement.