超声引导下胫后动脉置管在新生儿麻醉中的应用

Application of ultrasound-guided posterior tibial arterial catheterization in neonatal anesthesia

目的研究超声引导下胫后动脉置管在新生儿麻醉中的应用。方法选取2019年1月—2020年2月接受择期手术治疗,术中需行有创动脉血压监测及动脉血气分析的新生儿120例,ASA分级Ⅱ、Ⅲ级。按随机数字表法将患者分为胫后动脉组(J组)、桡动脉组(R组)与足背动脉组(Z组),每组40例。采用超声引导下平面外技术行动脉穿刺置管术,主要观察指标为首次穿刺成功率,同时记录置管时间、10 min内总成功率、动脉直径、动脉深度。结果J组和R组首次穿刺成功率高于Z组(P<0.05),置管时间短于Z组(P<0.05),动脉直径大于Z组(P<0.05)。J组动脉深度大于R组和Z组(P<0.05)。R组与J组10 min内总成功率小于Z组(P<0.05)。其余指标差异无统计学意义(P>0.05)。结论超声引导下胫后动脉置管在首次穿刺成功率及置管时间方面与桡动脉相当,优于足背动脉,在新生儿麻醉中可替代桡动脉置管。

Objective To investigate the application of ultrasound-guided posterior tibial arterial catheterization in neonatal anesthesia.Methods A total of 120 neonates[American Society of Anesthesiologists(ASA)gradesⅡorⅢ]who were scheduled for surgery from January 2019 to February 2020 were enrolled.During the surgery,invasive arterial pressure was monitored,while arterial blood gas was analyzed.According to the random number table method,the neonates were divided into three groups(n=40):a posterior tibial artery group(group J),a radial artery group(group R)and a dorsalis pedis artery group(group Z).Arterial catheterization was performed using ultrasound-guided out-of-plane procedures.The primary outcome was the first-attempt success rate of puncture.Meanwhile,the time of catheterization,a total success rate within 10 min,arterial diameter and depth were determined.Results Compared with group Z,groups J and R presented an increased first-attempt success rate of puncture(P<0.05)and an decreased time of catheterization(P<0.05),with an increased arterial diameter(P<0.05).The arterial depth in group J was larger than those in groups R and Z(P<0.05).Both groups R and J presented a less cumulative success rate than group Z within 10 min(P<0.05).There was no statistical difference in other indicators among those groups(P>0.05).Conclusions Ultrasound-guided posterior tibial arterial catheterization has a first-attempt success rate of puncture and catheterization time which is similar to the radial artery,and superior to the dorsalis pedis artery.It can be an alternative for catheterization of the radial artery during neonatal anesthesia.