平面内-平面外技术相结合的超声引导下桡动脉穿刺置管策略

Ultrasound-guided radial arterial cannulation combined with in-plane and out-of-plane approach

目的探讨平面内-平面外技术相结合的超声引导下桡动脉穿刺置管策略方法。方法选择择期心脏手术患者60例,随机分为平面内-平面外组(I-O组,先选择平面内技术穿刺,然后选择平面外技术穿刺,n=30)和平面外-平面内组(O-I组,先选择平面外技术穿刺,然后选择平面内技术穿刺,n=30)。记录2组桡动脉穿刺尝试次数、穿刺时间、首次成功率和首二次成功率,并观察并发症发生率。结果 I-O组与O-I组比较,穿刺尝试次数[2(1,2)次vs.1(1,3)次]和首次成功率(43.3%vs.56.7%),差异无统计学意义,但I-O组穿刺时间较短[48.50(31.00,66.25)svs.76.00(50.75,167.75)s]、首二次成功率较高(96.7%vs.66.7%)、并发症较少(血肿:10.0%vs.53.3%;桡动脉后壁穿透:16.7%vs.46.7%),差异有统计学意义(P<0.05)。结论在应用超声引导桡动脉穿刺技术时,先平面内后平面外技术首二次成功率较高,操作时间较短,安全性高,是超声引导桡动脉穿刺技术的较佳策略。

Objectives To explore the effectiveness of combined in-plane and out-of-plane ultrasound-guided radial arterial cannulation with the opposite approaches. Methods Sixty elective cardiac surgical patients were randomized into two groups： the I-O group （n=30, radial arterial cannulation with in-plane technique followed by out-of-plane technique） and the O-I group （n=30, radial arterial cannulation with out-of-plane technique followed by in-plane tech- nique）. The times of cannulation attempts, cannulation time, success rate at first-time attempt and first two attempts were recorded, as well as complications. Results The times of cannulation attempts [2 （1,2） vs. 1 （1,3）] and success rate at first-attempt （43.3% vs. 56.7%） were similar between the two groups. However, cannulation time was significantly shorter in the I-O group[ 48.50 （31.00, 66.25）s] compared with the O-I group [76.00 （50.75,167.75）s, P 〈 0.05]. The success rate at the first two attempts was significantly higher （96.7% vs. 66.7%, P 〈 0.05） and complications were significantly less in the I-O group compared with the O-I group （hematoma： 10.0% vs. 53.3%, P 〈 0.05; posterior wall damage： 16.7% vs. 46.7%, P 〈 0.05）. Conclusion Sequential in-plane then out-of-plane ultrasound-guided radial arterial cannulation is a better strategy compared with the opposite approach due to higher success rate at the first two attempts, shorter cannulation time and less complications.