拇指血流灌注指数试验与改良Allen试验的比较

Evaluation of the patency of the hand collateral arteries with thumb perfusion index test:comparison with themodified Allen's test

目的探讨拇指血流灌注指数(perfusion index,PI)试验替代改良Allen试验(modified Allen’s test,MAT)评价掌部组织侧支循环血流灌注的可行性。方法选择1 108例拟行择期手术并需要经桡动脉进行有创动脉压力监测的患者,在桡动脉穿刺前先后用MAT和拇指PI值试验分别评价患者试验侧掌部组织侧支循环血流灌注的情况,并将2种试验方法结果进行统计学比较和分析。结果在1 108例患者中MAT阴性患者1 035例(93.41%),阳性患者73例(6.59%);拇指PI值试验阴性患者1 090例(98.38%),其中包括57例MAT阳性患者,阳性患者18例(1.62%)。拇指PI值试验阴性患者行经该侧桡动脉进行有创动脉压力监测,2种试验方法结果进行χ~2检验,差异有统计学意义(χ~2=51.27,P<0.05)。对2种试验方法影响因素进行Logistic回归分析,发现2种试验方法结果阳性率均与年龄及性别有相关性(P<0.05)。结论在本研究中用拇指PI值试验筛选出1.62%的患者不宜行经桡动脉进行有创动脉压力监测,其敏感性高于MAT,并且该方法简单、方便,值得在临床工作中推广,可用于替代MAT来评价掌部组织侧支循环血流灌注的情况。

Objective To evaluate the patency of the hand collateral arteries and to compare modified Allen ＇s test（ MAT） with thumb perfusion index（ PI） test before radial artery puncture. Methods Patients scheduled to undergo selective major surgery were prospectively examined with MAT and thumb PI test before radial artery puncture. Two tests＇ results were either positive or negative. Results of both tests were compared in 1 108 patients. Results Among 1 108 patients,two tests both negative was in 1 033 cases; two tests both positive was in 16 cases; the MAT positive,thumb PI test negative was in 57 cases; the MAT negative,thumb PI test positive was in 2 cases,with Chi-square test（ χ2= 51. 27,P 〈0. 05）. It meant that there was statistical differences used to evaluate the patency of the hand collateral arteries. The influencing factors were analysed by stepwise logistic regression analyses found that positive rate is related to age and gender by using both methods（ P 〈0. 05）. Conclusion The result of thumb PI test show more sensitive than MAT. When applied to radial approach screening,1. 62% of patients were not suitable candidates for radial artery puncture. Furthermore,thumb PI test is simpler and convenient compared with MAT in the evaluation of hand collateral arteries,which can replace MAT in clinical application.