改良超声引导下桡动脉穿刺置管技术在ICU休克患者中的临床研究

Transradial catheterization guided by improved ultrasonic technology for shock patients in ICU

目的观察先平面外定位再平面内引导的超声技术在ICU休克患者行桡动脉穿刺置管中的指导效果,明确此应用对穿刺置管安全性的影响。方法将106例ICU休克患者随机分为平面内超声组(对照组)和改良超声技术组(试验组)。2组均采用静脉持续镇痛镇静。平面内组采用平面内超声引导技术行桡动脉穿刺置管;改良组采用先平面外定位再平面内引导的方法行桡动脉穿刺置管。记录并比较2组的一次穿刺成功率、穿刺失败率(穿刺3次未成功)、穿刺时间、并发症发生情况,以确定先平面外定位再平面内引导的超声技术在ICU休克患者行桡动脉穿刺置管中的指导作用。结果 (1)改良组一次穿刺置管成功率为81.3%,平面内组为40.4%,改良组高于平面内组(P<0.05)。(2)改良组穿刺置管时间为(8.38±6.10)s,平面内组为(24.07±21.38)s,改良组短于平面内组(P<0.01)。(3)改良组血肿和穿刺口渗血发生率分别为2.1%和4.2%,平面内组分别为14.9%和10.6%,并发症发生率改良组小于平面内组(P<0.05)。结论对ICU休克患者采用先平面外定位再平面内引导的方法行桡动脉穿刺置管一次穿刺成功率高,穿刺时间短,并发症发生率低。

Objective To observe the effects of the improved ultrasound technology with out-of-plane orientation followed by in-plane guide for shock patients in ICU, and evaluate its safety. Methods Total 106 cases of shock in ICU were ran- domly divided into in-plane approach group（ control group） and improved ultrasound group（ experimental group）. The pa- tients in both groups were treated with intravenous sedation and analgesia. The radial artery puncture and catheterization in the control group was guided by in-plane approach, while in the experimental group by out-of-plane orientation followed by in-plane technique. One-time success rate and failure rate of puncture （punctured three times without success）, time for puncture and incidence of complications were compared between the two groups. Results ①One-time success rate of the experimental group（81.3% ） was significant higher than that （40.4%） of the control group, P 〈 0.05. ②The time for catheterization of the experimental group[ （8.38 ±6.10 ） seconds ] was significant shorter than that[ （24.07±21.38 ） seconds） of control group] , P 〈 0.01. ③The incidence of hematoma and puncture oozing of the experimental group （2.1% and 4.2% ） were significant less than those（ 14.9% and 10.6% ） of the control group,P 〈0.05. Conclusion Compared to the in-plane method, the improved ultrasound technology with out-of-plane orientation followed by in-plane guide for shock patients in ICU can improve the one-time success rate of puncture, decrease time for the puncture and re- duce the incidence of complications.