Kim Eun-Hee, Lee Ji-Hyun, Song In-Kyung, Kim Jin-Tae, Lee Won-Jong, Kim Hee-Soo
From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Anesthesiology. 2017 Sep;127(3):423-431. doi: 10.1097/ALN.0000000000001774.
We evaluated the posterior tibial artery as an alternative arterial cannulation site to the radial artery in small children.
A two-stage study was conducted. First, we evaluated the anatomical characteristics of the posterior tibial artery compared with the radial and dorsalis pedis arteries. Next, a parallel-arm single-blind randomized controlled study compared the initial success rate of ultrasound-guided arterial cannulation among three arteries as a primary outcome.
Sixty patients were analyzed in the observational study. The diameter of the posterior tibial artery (1.5 ± 0.2 mm) was similar to that of the radial artery (1.5 ± 0.2 mm) and larger than that of the dorsalis pedis artery (1.2 ± 0.2 mm; P < 0.001). The posterior tibial artery has a larger cross-sectional area (2.8 ± 1.1 mm) compared with the radial (2.3 ± 0.8 mm; P = 0.013) and dorsalis pedis arteries (1.9 ± 0.6 mm; P = 0.001). In total, 234 patients were analyzed in the randomized study. The first-attempt success rate of the posterior tibial artery (75%) was similar to that of the radial (83%; P = 0.129; odds ratio, 1.53; 95% CI, 0.69 to 3.37) and higher than that of the dorsalis pedis artery (45%; P < 0.001; odds ratio, 3.95; 95% CI, 1.99 to 7.87). Median cannulation time of the posterior tibial artery (21 s; interquartile range, 14 to 30) was similar to that of the radial artery (27 s; interquartile range, 17 to 37) and shorter than that of the dorsalis pedis artery (34 s; interquartile range, 21 to 50).
The posterior tibial artery is a reasonable alternative to the radial artery for ultrasound-guided arterial cannulation in small children.
我们评估了小儿胫后动脉作为桡动脉以外的动脉穿刺部位的可行性。
进行了一项两阶段研究。首先，我们评估了胫后动脉与桡动脉和足背动脉相比的解剖学特征。接下来，一项平行组单盲随机对照研究将三条动脉超声引导下动脉穿刺的首次成功率作为主要结局进行比较。
在观察性研究中分析了60例患者。胫后动脉直径（1.5±0.2mm）与桡动脉（1.5±0.2mm）相似，且大于足背动脉（1.2±0.2mm；P<0.001）。与桡动脉（2.3±0.8mm；P = 0.013）和足背动脉（1.9±0.6mm；P = 0.001）相比，胫后动脉的横截面积更大（2.8±1.1mm）。在随机研究中总共分析了234例患者。胫后动脉的首次穿刺成功率（75%）与桡动脉（83%；P = 0.129；比值比，1.53；95%CI，0.69至3.37）相似，且高于足背动脉（45%；P<0.001；比值比，3.95；95%CI，1.99至7.87）。胫后动脉的中位穿刺时间（21秒；四分位间距，14至30）与桡动脉（27秒；四分位间距，17至37）相似，且短于足背动脉（34秒；四分位间距，21至50）。
对于小儿超声引导下动脉穿刺，胫后动脉是桡动脉的合理替代部位。
