超声引导下动态针尖定位法在初学者桡动脉穿刺置管中的效果评定

Assessment of the effect of ultrasound-guided dynamic needle tip positioning method in radial artery puncture and catheterization for beginners

目的比较超声引导下动态针尖定位法(DNTP)和传统盲探触摸法(BP)在初学者桡动脉穿刺置管中的效果。方法选取2019年7月至2020年1月在河南大学第一附属医院麻醉科实习的64名初学者纳入研究,根据交叉设计方法分别使用DNTP法和BP法对128例患者行桡动脉穿刺置管操作。所有初学者均提前接受理论教学和模型操作练习。主要结果是10 min成功率,次要结果是首次成功率、穿刺成功率、置管成功率、操作时间、操作次数、套管针使用数量和相关血管并发症等。结果DNTP法和BP法中10 min成功率分别为65.6%(42/64)和35.9%(23/64),差异有统计学意义(P<0.05);操作时间中位数分别为258 s和600 s,差异有统计学意义(P<0.05);置管成功率分别为89.3%(42/47)和45.1%(23/51),差异有统计学意义(P<0.05)。两种方法穿刺成功率和首次成功率,分别是73.4%(47/64)和79.7%(51/64),26.6%(17/64)和20.3%(13/64),差异无统计学意义(P>0.05)。结论与传统BP法相比,DNTP法明显提高了初学者桡动脉穿刺置管的成功率。

Objective To compare the effect of ultrasound-guided dynamic needle tip positioning(DNTP)and traditional blind probing(BP)method in radial artery puncture and catheterization for beginners.Methods A total of 64 beginners practicing in the Department of Anesthesiology,the First Affiliated Hospital of Henan University from July 2019 to January 2020 were included in the study,and radial artery puncture and catheterization operations were performed using the DNTP method and the BP method for 128 patients,respectively,according to the crossover design method.All beginners received theoretical teaching and model operation practice in advance.The primary outcome was the 10-minute success rate,and the secondary outcomes were first-time success rate,puncture success rate,catheterization success rate,operation time,number of operations,number of trocars used,and associated vascular complications.Results For the DNTP and BP methods,the 10-minute success rates were 65.6%(42/64)and 35.9%(23/64),respectively,with statistically significant differences(P<0.05).The median operation times were 258 s and 600 s,respectively,with statistically significant differences(P<0.05).The success rates of catheterization were 89.3%(42/47)and 45.1%(23/51),respectively,with statistically significant differences(P<0.05).The success rates of catheterization in the two methods were 73.4%(47/64)and 79.7%(51/64),and the first-time success rate 26.6%(17/64)and 20.3%(13/64),respectively.There was no statistically significant difference in the both rates of the two methods(P>0.05).Conclusion Compared with the conventional BP method,the DNTP method significantly improved the success rate of radial artery puncture and catheterization for beginners.