便携式超声引导桡动脉置管

Use of ultrasound guidance in the insertion of radial artery catheters

目的评估便携式超声在桡动脉置管的作用。方法选择美国麻醉医师协会（ASA）分级I～Ⅱ级要求术中动脉置管监测的择期手术患者132例，采用随机数字表法分成两组，每组66例：超声组（B组）和触摸技术组（A组）。记录两组从皮肤穿刺开始到成功置入导管的时间、每次穿刺的时间和穿刺的次数。然后，进行可视化便携式超声桡动脉置管和触摸技术桡动脉置管这两种技术比较。结果超声引导组有4例穿刺失败，同时触摸技术组也有4例失败，4例排除在有效观察资料之外，所以各组有效观察对象是62例。两组首次穿刺成功的例数比较，B组大于A组（P〈0．05），B组一次动脉插管成功39人（63％），同时A组21人（34％）；总穿刺数比较，B组（98）明显小于A组（195）（P〈0．05）；B组与A组比较显著减少了穿刺次数（均数±标准差），（1．6±2．0）与（3．1±2．4）（P〈0．05），但是，任一次成功穿刺的时间长（27．1±2．5）S与（17．5±1．8）s（P〈0．05），超声引导组所需总时间较短（56±64）S与（112±124）s（P〈0．05）。结论超声引导在挠动脉导管插入中是一种有用的辅助措施，增加挠动脉一次插管的成功率。技术简单易学，并减少挠动脉置管花费的时间。

Objective To assess the role of a portable ultrasound device in the insertion of radial artery catheters. Methods Elective surgery 132 patients [American society of anesthesiologists （ASA） grades I - II ] requiring arterial catheter insertion for intraoperative monitoring. A total of 132 patients requiring an arterial catheter were randomized to either the ultrasound （B group, 66 patients） or palpation technique （A group, 66 patients）. The time taken from skin puncture to successful arterial catheter insertion, the time taken per insertion attempt, and the number of attempts required were recorded for each group. A portable ultrasound device was used to visualize the radial artery at the wrist and to direct arterial catheter insertion. This new technique of arterial catheter insertion was compared with the classic palpation technique. Results There were four failures in the ultrasound group and four in the palpation group （not significant）. Four cases out of the valid observations outside, so effectively observe objects in each group was 62 cases. Two groups of puncture succeed for the first time the example number compares B group to be bigger than A group （P〈0.05）, The arterial eannula was inserted on the first attempt in 39 （63%）eases using ultrasound（B group） vs 21（34%） cases by palpation（A group） （P〈0.05）; The total puncture number compares B group （98） to be smaller than obviously A group （195）（P〈0.05）, Significantly fewer attempts were required for catheter insertion using ultrasound as compared with palpation （mean±SD）, （1.6±2.0） and （3.1±2.4） （P〈0.05） ; however, the time taken for each successful attempt was longer （27.1±2.5） s and （17.5± 1.8 ） s （P〈0.05）. The shorter overall time required for catheter insertion was found for the ultrasound group （56±64） s and （112±124） s （P〈O.05）. Conclusions Ultrasound is a useful adjunct to radial arterial catheter insertion and increases the rate of success at first attempt. The technique is easy to learn and can reduce the time taken to insert the catheter.