Dahl M R, Smead W L, McSweeney T D
Department of Anesthesiology, Ohio State University, Columbus.
J Clin Monit. 1992 Jul;8(3):193-7. doi: 10.1007/BF01616775.
Eighty-nine patients were studied prospectively to compare the incidence of postdecannulation arterial thrombosis and ischemic complications associated with percutaneous insertion of two different radial artery catheters. Patients scheduled for peripheral vascular surgery were randomized to receive a 15.2-cm (6 in, Argon Medical Corp.) or 4.45-cm (1.75 in, Arrow International, Inc.) 20-gauge, Teflon catheter. Extremity blood flow was evaluated prior to cannulation and again after decannulation with the modified Allen's test, pulse-volume plethysmography, and Doppler ultrasound. The incidence of postdecannulation radial artery occlusion for 15.2-cm catheters was significantly less than for 4.45-cm catheters (4 of 45 cases versus 11 of 44 cases, p = 0.05). No case of temporary or permanent ischemic injury occurred. Radial artery transfixion (16 of 45 cases versus 5 of 44 cases, p = 0.01) and hematoma formation (5 of 45 cases versus 0 of 44 cases, p = 0.02) occurred more frequently during insertion of 15.2-cm catheters than 4.45-cm catheters. The number of arterial punctures during catheter insertion and the duration of cannulation were similar for both groups. Of the 8 patients with positive modified Allen's test who underwent radial artery cannulation, one suffered arterial occlusion. Radial artery cannulation with a 15.2-cm catheter was associated with a lower incidence of postdecannulation radial artery thrombosis than cannulation with the 4.45-cm catheter. Radial artery cannulation with longer catheters (greater than 5.0 cm) appears to be a safe practice.
对89例患者进行前瞻性研究，以比较经皮插入两种不同桡动脉导管后脱管后动脉血栓形成和缺血性并发症的发生率。计划进行外周血管手术的患者被随机分配接受15.2厘米（6英寸，氩气医疗公司）或4.45厘米（1.75英寸，箭牌国际公司）的20号聚四氟乙烯导管。在插管前和脱管后再次用改良艾伦试验、脉搏容积描记法和多普勒超声评估肢体血流。15.2厘米导管脱管后桡动脉闭塞的发生率显著低于4.45厘米导管（45例中的4例对44例中的11例，p = 0.05）。未发生临时或永久性缺血性损伤病例。15.2厘米导管插入过程中桡动脉穿刺（45例中的16例对44例中的5例，p = 0.01）和血肿形成（45例中的5例对44例中的0例，p = 0.02）比4.45厘米导管更频繁。两组导管插入期间的动脉穿刺次数和插管持续时间相似。在8例经改良艾伦试验阳性且接受桡动脉插管的患者中，1例发生动脉闭塞。与使用4.45厘米导管插管相比，使用15.2厘米导管进行桡动脉插管后桡动脉血栓形成的发生率更低。使用较长导管（大于5.0厘米）进行桡动脉插管似乎是一种安全的做法。
