超声引导法桡动脉置管对血管损伤并发症发生率及恢复情况的影响

doi:10.3969/j.issn.1005-6483.2021.09.025

摘要/Abstract

摘要： 目的观察超声引导法桡动脉置管对血管损伤、并发症发生率及恢复情况的影响。
方法 2019年9月1日～2020年9月1日在我院手术病人100例，ASAⅠ～Ⅱ级，随机分成两组：超声引导法桡动脉置管组(实验组，S组)，盲法触摸桡动脉置管组(观察组，M组)，两组均行桡动脉穿刺置管监测血压。采用脉冲多普勒超声测量T1(动脉置管前)、T2(动脉置管成功后)、T3(拔除动脉置管前)、T4(拔除动脉置管后15分钟)、T5(拔除动脉置管后1小时)、T6(拔除动脉置管后2小时)、T7(拔除动脉后6小时)、T8(拔除动脉后12小时)8个时间点穿刺桡动脉血流参数：桡动脉血管直径(D)、时间平均最大速度(TAMax)、阻力指数(RI)、搏动指数(PI)、血管横截面积(Area)、桡动脉远端血流量(F)，比较组间和组内各时间点血管直径、血流量、阻力指数、搏动指数的变化，动脉置管拔管后并发症的发生率以及恢复情况。
结果组内比较,与T1时相比，两组病人T2～T8时D、F的变化趋势为先下降，后回升，再下降，再回升，RI、PI的变化为先升高，后回降，再升高，再回降，S组F、RI、PI在T8时恢复至T1水平(P>0.05)，M组F、RI、PI在T8尚未恢复至T1水平见(P<0.05)；组间比较，两组病人D、F、RI、PI在T1时比较均无明显差异(P>0.05)，与M组相比，S组在T2～T5时的D较大(P<0.05)，在T2～T8时的F较高(P<0.05)，在T2～T8时的RI及PI较低(P<0.05)，S组动脉拔管后并发症的发生率明显降低(P<0.05)。
结论超声引导法较盲法桡动穿刺脉置管对桡动脉损伤小、穿刺点远端血流影响小，并发症发生率减少，且损伤恢复快。

关键词: 超声引导, 动脉置管, 动脉血流, 并发症

Abstract: Objective To observe the influence of ultrasound-guided radial artery catheterization on vascular injury,complication rate and recovery.
Methods From September 1 2019 to September 1 2020,a total of 100 patients undergoing surgery in our hospital were randomly divided into two groups:ultrasound-guided radial artery catheterization group(group S),blind touch radial artery catheterization group(group M),both groups underwent radial artery catheterization to monitor invasive arterial blood pressure.Doppler ultrasound(Mindray,M9) was used to measure blood flow parameters of radial artery catheterization at 8 time points:T1(before arterial catheterization),T2(after successful arterial catheterization),T3(before removing artery catheterization),T4,T5,T6,T7,T8(15 min,1 h,2 h,6 h,12 h after removing artery catheterization),blood flow parameters include:Radial artery diameter(D),Time average maximum speed(TAMAX),Resistance index(RI),Pulsatility index(PI),Vascular cross-sectional area(Area),distal radial artery blood flow(F).Compare the changes of blood vessel diameter,blood flow,resistance index,and pulsatility index at each time point between groups and within groups,also the incidence of complications and recovery after extubation of arterial catheterization.
Results Compared with T1,The trend of changes in D,F in the two groups of patients from T2 to T8 was first decline,then rise,then fall,and then rise again,the RI and PI are first increase,then decrease,then increase,and then decrease.At the point T8,the F,RI,PI recovered to T1 level in Group S(P>0.05),and that have not recovered to T1 level in group M(P<0.05).Comparison between groups,there was no significant difference in D,F,RI,PI in the two groups at T1(P>0.05).Compared with the group M,thegroup S had a larger D at T2-T5(P<0.05),a higher F at T2～T8(P<0.05),and a lower RI and PI at T2～T8(P<0.05),the incidence of complications after arterial extubation was significantly reduced in group S(P<0.05).
Conclusion Compared with the blind radial catheterization,the ultrasound-guided method has less damage to the radial artery,less impacton the blood flow at the distal end of the catheterization site,reduced complication rate,and faster recovery from the injury.It is worthy of clinical promotion.

Key words: ultrasound guidance, arterial catheterization, arterial blood flow, complications

吴豪余挺李麟殷国江谈世刚夏中元. 超声引导法桡动脉置管对血管损伤并发症发生率及恢复情况的影响[J]. 临床外科杂志, 2021, 29(9): 889-891.

WU Hao, YU Ting, LI Lin, et al.. Ultrasound-guided radial artery catheterization reduced vascular injury,complication and enhanced recovery[J]. JOURNAL OF CLINICAL SURGERY, 2021, 29(9): 889-891.

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