盲法与超声引导下进行儿童股动脉穿刺的自身对照研究

The traditional blind and ultrasound-guided femoral artery puncture in children:a self-controlled cohort study

目的比较传统盲穿法与超声引导下进行儿童股动脉穿刺的操作耗时、穿刺次数和并发症情况,同时探讨超声引导下股动脉穿刺操作的学习曲线规律。方法选取我科一名工作10年以上的儿科介入主治医师,收集分析2020年1月至2020年12月期间由该名医师采用传统盲法完成的股动脉穿刺病例共104例(盲穿组)的临床资料,同时收集其分析2021年1月至2021年12月期间在高年资医师指导下采用超声引导进行股动脉穿刺的病例共120例(超声引导组)临床资料,比较两组操作耗时、穿刺次数、穿刺成功率和并发症情况。将超声引导组进一步细分为A、B、C、D、E、F、G、H共8组,进行学习曲线分析。结果超声引导组前三次成功率均明显高于盲穿组;穿刺时间及平均穿刺次数明显低于盲穿组;不良反应发生率显著低于盲穿组。A~E组间操作耗时均存在统计学差异(P<0.05),E~H组间操作耗时无统计学差异(P>0.05)。8组并发症发生率无统计学差异(P>0.05)。结论与盲穿法相比,采用超声引导下进行儿童股动脉穿刺,成功率高,时间短,不良反应发生率低。此外,实时超声引导下儿童股动脉穿刺学习曲线拐点为75例左右,其并发症在学习曲线的早期和成熟期没有区别,具有同样的安全性。

Objective To compare the operation time,puncture times and complications of traditional blind and ultrasound-guided femoral artery puncture(US-FAP)in children,and to explore the learning curve of US-FAP,so as to provide reference for the application of US-FAP in children.Methods The clinical data of 104 cases(blind puncture group)of femoral artery puncture completed by a pediatric interventional radiologist who has worked in our department for more than 10 years were collected and analyzed from January 2020 to December 2020.The clinical data of 120 cases(ultrasound-guided group)underwent US-FAP from January 2021 to December 2021 were collected and analyzed.The operation time,puncture times,puncture success rate and complications of blind puncture group and ultrasound-guided group were compared.The ultrasound-guided group was further divided into 8 groups names as A,B,C,D,E,F,G and H,and the learning curve was also analyzed.Results The success rate of one-time,two-time and three-time puncture were significantly higher than those in blind puncture group.The puncture time and average puncture times were significantly lower than those in the blind puncture group.The incidence of adverse reactions was significantly lower than that in the blind puncture group.There was significant difference in operation time between groups A~E(P<0.05).There was no significant difference between groups E~H(P>0.05).There was no significant difference in the incidence of complications among the eight groups(P>0.05).Conclusions Compared with blind puncture,ultrasound-guided femoral artery puncture in children has higher success rate,shorter time and lower incidence of adverse reactions.In addition,75 cases of ultrasound guided femoral artery puncture are expected to pass through the turning point of the learning curve safely.There was no difference between the early and mature stages of the learning curve and both were the same safe.