穿刺置管术中桡动脉痉挛影像特点的超声学研究

An ultrasound study in the imaging features of the vessel spasm during the radial artery puncture procedure

目的探讨穿刺术中桡动脉痉挛(RAS)的影像特点及其影响因素。方法使用高频超声观察局麻和全麻状态下行桡动脉穿刺患者的血管影像特点,并测量穿刺前后桡动脉内径(RAD-1、RAD-2)及狭窄段长度(L-Spasm)。结果 264例患者中发生RAS者131例,发生率为49.6%;其中影像特点RAS可以分为局限痉挛、局部痉挛和弥漫痉挛三种类型。两组患者穿刺前桡动脉内径RAD-1差异无统计学意义(P>0.05);穿刺术后,全麻组桡动脉内径RAD-2较局麻组明显减小,而L-Spasm较后者明显增大(P<0.05)。通过logistic回归分析证实,女性、高龄(≥60岁)、糖尿病及RAD-1≤2mm者是RAS的高危人群,穿刺时间长及穿刺次数增多可引起并加重RAS,利多卡因局部浸润麻醉有助于减少RAS的发生率(P=0.017,OR=0.446)。结论 RAS发生率相对较高,其影像特点和影响因素亦众多;局部使用利多卡因有助于减少RAS的发生。

Objective To investigate the imaging features and its influence factors of the radial artery spasm（RAS） by ultrasonography during the puncture procedure.Methods 6The ultrasonography was applied to the observer the imaging features of RAS during the local and general anesthesia.The diameter of the radial artery before and after the puncture procedure was calculated（RAD-1,RAD-2）,and the length of the spasm（L-Spasm）was calculated meanwhile.Results Of the 264cases,131cases（49.6%）get RAS.And the RAS could be discribed as local RAS,sectional RAS and diffuse RAS,according to the ultrasonic imaging features.There was no statistically significant difference of the parameters of RAD-1between the two groups（P0.05）.The RAD-1of general anesthesia groups was smaller than the former groups,while the L-Spasm is much bigger（P0.05）.According to logistic regression analysis,the old（≥60y） female patients with diabetes and small RAD-1（≤2mm）have a high risk of RAS,and local anesthesia with idocaine is helpful to reduce the ratio of RAS.Conclusion With a high ratio,many influence factors could be detected of the RAS,the idocaine can be used to prevent RAS.