婴儿钢丝导引法与直接穿刺法动脉置管效果的比较

Direct versus Guidewire-assisted Artery Cannulation in Infants

目的:比较对1岁的婴儿进行动脉穿刺置管时用钢丝导引法和直接穿刺法置管的失败率和操作时间。方法:105例小于1岁择期行简单先天性心脏病矫治手术的婴儿在麻醉诱导后随机分为2组,组1用直接穿刺法,组2用钢丝导引法进行动脉穿刺置管。记录各组置入外套管所耗费的时间,各组置入外套管前失败的总次数以及各组出现血肿的例数。结果:组1(55例)每例置管的平均时间(23±4.7min)明显长于组2(50例)(8±3.4min)(P<0.05)。组1总共试刺203次,置管失败的危险度为0.73;组2共试穿69次,置管失败的危险度为0.28,两者有显著差异(P<0.05)。组2对组1置管失败的危险比为0.38;绝对危险减少为0.45(95%CI,0.28～0.61);为减少1次不良事件需要干预的病例数为3(95%CI,4～2)。结论:钢丝导引法可大幅度降低小婴儿动脉穿刺置管的失败率,明显节约时间。

Objective：Artery cannulation is a difficult procedure in infants and more attempts are needed.The purpose of this study was to compare direct artery cannulation with guidewire-assisted cannulation in infants.Methods：105 infants undergoing minor cardiac surgery,who required artery catheters,were divided randomly into 2 groups：group 1 included 55 patients who had artery cannulation with the direct technique,while group 2 included 50 patients who had the guidewire-assisted artery cannulation.Elapsed time for each cannulation and total attempts until success of cannulation in each group were recorded.Undesired results including hematoma or switching to cutdown technique were also noted.Results：Percutaneous artery cannulation succeeded for all the patients finally.Mean elapsed time for group 1 was significantly less than that of group 2（23±4.7 min vs 8±3.4 min,P〈0.05）.Total attempts were 203 in group 1 and 69 in group 2.Risk of failure was 0.73 and 0.28,respectively（P〈0.05）.The risk ratio（group 2 to group 1） was 0.38 and the absolute risk reduction（risk of group 1 minus risk of group 2） was 0.45（95% CI,0.28～0.61）.Number needed to treat in order to prevent one event（NNT） was 3（95% CI,4～2）.Conclusion：The guidewire-assisted technique provided quick artery cannulation with low rate of failure in infants.