超声定位与盲法用于创伤后循环不稳患者桡动脉穿刺的比较

Comparison of ultrasound - guided and conventional radial artery cannulation in hemodynamically unstable patients with traumatic injury

目的比较超声定位法与旨法用于创伤后循环不稳患者桡动脉穿刺的效果。方法采用前瞻性随机分组设计，纳入标准为外伤后拟行急诊手术，因循环不稳（定义为人手术室时平均动脉压〈60mmHg或休克指数〉1）需动脉穿刺测压患者，纳入患者40例随机分为超声定位组和盲法组行桡动脉穿刺。考察指标包括首次穿刺成功率、总成功率、总操作时间和总穿刺次数。结果两组间一般资料差异无统计学意义；与盲法组相比，虽然两组总穿刺成功率差异无统计学意义，但超声定位组首次穿刺成功率高（19例比13例，P〈0．05），总操作时间短[（1．2±0．5）min比（2．8±2．5）min，P〈0．01]，总穿刺7欠数少[（1．2±0．4）次比（2．1±1．5）次，P〈0．01]。结论对于创伤后循环不稳需行桡动脉穿刺患者，超声定位法桡动脉穿刺效果优于传统盲法。

Objective To compare the ultrasound -guided （UG）versus traditional palpation （TG） placement of arterial lines in hemodynamically unstable patients with traumatic injury. Methods A total of 40 patients were prospectively assigned to either UG or TG groups at random. The adult traumatic patients with hemodynamic instability（ defined as mean arterial pressure less than 60 mmHg or shock indenx 〉 1.0 by arrival at operating theatre） who would underwent arterial catheterization for invasive monitoring were included in this study. The observative items included the success rate of cannulation at the first attemp,the number of attempts required,the time taken from skin puncture to arterial catheter insertion and overall success rate. Fishers exact, Mann - Whitney and Students t - tests were used for statistical analysis. Results There were no statistically significant differences in age, gender, weight, depth and diameter of artery, heart rate and blood pressure during arterial catheter insertion between the two groups. Ultrasound -guided puncture was successfully completed in 19 patients compared to 13 patients in TG group at the first attempt （ P 〈 0.05 ）. Patients in the UG group had a shorter time for arterial line placement （ 1.2±0.5 min vs. 2.8 ±2.5 min ,P 〈 0.01 ） and fewer placement attempts（ 1.2 ±0.4 vs. 2.1 ±1.5 ,P 〈 0.01 ） than those in the TG group. There was no statistically significant difference between the groups regarding the overall success rate. Conclusion Ultrasound is a useful adjunct to radial arterial catheter insertion, and increases the rate of success at first attempt in hemodynamically unstable patients with traumatic injury.