二维灰阶血流成像联合彩色多普勒血流成像引导大面积烧伤患者经创面动脉穿刺置管的效果

Effects of two dimensional gray-scale blood flow imaging combined with color Doppler flow imaging in guiding arterial puncture and catheterization through wounds in patients with large burns

目的探讨二维灰阶血流成像(以下简称B-flow)联合彩色多普勒血流成像(CDFI)引导大面积烧伤患者动脉穿刺置管的效果。方法2017年1月-2019年1月,吉林大学第一医院收治的67例大面积烧伤患者符合入选标准,纳入本前瞻性随机对照研究。按照随机数字表法将患者分为单纯CDFI组35例(男23例、女12例)和B-flow+CDFI组32例(男22例、女10例),其年龄分别为19~60、18~58岁。根据病情进展,择机进行动脉穿刺置管,操作过程中单纯CDFI组患者仅采用CDFI引导,B-flow+CDFI组患者联合应用B-flow和CDFI引导。以首次置管为基础,统计2组患者置管部位,一次穿刺置管成功、回针后复穿置管成功及置管失败的发生率,置管耗时,置管后3 d内创面脓毒症、导管相关性血流感染及动脉血栓发生情况。对数据行独立样本t检验和χ^2检验或Fisher确切概率法检验。结果(1)患者均经创面置管,2组患者置管部位比较,差异无统计学意义(χ^2=0.574,P>0.05)。(2)B-flow+CDFI组患者一次穿刺置管成功率为81.25%(26/32),明显高于单纯CDFI组的51.43%(18/35),χ^2=6.594,P<0.05;置管失败率为3.12%(1/32),明显低于单纯CDFI组的20.00%(7/35),P<0.05;回针后复穿置管成功率与单纯CDFI组相近(χ^2=1.029,P>0.05)。(3)B-flow+CDFI组患者置管耗时为(15.7±1.1)min,明显短于单纯CDFI组的(17.1±2.2)min(t=11.316,P<0.01)。(4)单纯CDFI组患者置管后3 d内创面脓毒症和导管相关性血流感染发生率分别为2.86%(1/35)、0,与B-flow+CDFI组的0和3.12%(1/32)相近(P>0.05);B-flow+CDFI组患者置管后3 d内动脉血栓发生率为0,明显低于单纯CDFI组的20.00%(7/35),P<0.05。结论相较于单纯CDFI,B-flow联合CDFI可以提高大面积烧伤患者经创面动脉穿刺置管成功率,缩短置管耗时,并可以有效降低置管后动脉血栓发生率,具有很好的临床应用价值。

To explore the effects of two dimensional gray-scale blood flow imaging(hereinafter referred to as"B-flow")combined with color Doppler flow imaging(CDFI)in guiding arterial puncture and catheterization through wounds in patients with large burns.Methods Sixty-seven patients with large burns who met the inclusion criteria and hospitalized in the First Hospital of Jilin University from January 2017 to January 2019 were enrolled in the prospectively randomized control study.According to the random number table,CDFI alone group was allocated with 35 patients(23 males and 12 females)and B-flow+CDFI group with 32 patients(22 males and 10 females),aged 19-60 and 18-58 years,respectively.According to the progress of the disease,arterial puncture and catheterization were performed in the right time.During the operation,CDFI was used alone for guidance in patients of CDFI alone group,while B-flow and CDFI were used together for guidance in patients of B-flow+CDIF group.Based on the first time of catheterization,the catheterization location,one-time catheterization success rate,post-back stitching re-catheterization success rate,catheterization failure rate,catheterization duration,and incidences of wound sepsis,catheter-related bloodstream infection,and arterial thrombosis within post catheterization day(PCD)3 of patients in the two groups were recorded.Data were statistically analyzed with the independent-sample t test,chi-square test or Fisher′s exact probability test.Results(1)All the patients underwent catheterization through wounds,and there was no statistically significant difference in catheterization location of patients between the two groups(χ^2=0.574,P>0.05).The one-time catheterization success rate of patients in B-flow+CDFI group was 81.25%(26/32),which was obviously higher than 51.43%(18/35)in CDFI alone group(χ^2=6.594,P<0.05).The catheterization failure rate of patients in B-flow+CDFI group was 3.12%(1/32),which was obviously lower than 20.00%(7/35)in CDFI alone group(P<0.05).The post-back stitching re-catheterization success rate of patients was similar between the two groups(χ^2=1.029,P>0.05).(3)The catheterization duration of patients was(15.7±1.1)min in B-flow+CDFI group,which was obviously shorter than(17.1±2.2)min in CDFI alone group(t=11.316,P<0.01).(4)Within PCD 3,the incidences of wound sepsis and catheter-related bloodstream infection of patients in CDFI alone group were 2.86%(1/35)and 0,close to 0 and 3.12%(1/32)in B-flow+CDFI group(P>0.05);the incidence of arterial thrombosis of patients in B-flow+CDFI group was 0,which was obviously lower than 20.00%(7/35)in CDFI alone group(P<0.05).Conclusions Compared with CDFI alone,B-flow combined with CDFI can improve the success rate of arterial puncture and catheterization through wounds in large area burn patients,shorten the catheterization duration,and effectively reduce the incidence of arterial thrombosis after catheterization,with a good clinical application value.