超声引导与触诊引导技术在婴儿桡动脉置管中的应用：一项随机对照试验。

Ultrasound-guided vs. palpation-guided techniques for radial arterial catheterisation in infants: A randomised controlled trial.

出版信息

Eur J Anaesthesiol. 2019 Mar;36(3):200-205. doi: 10.1097/EJA.0000000000000926.

Abstract

BACKGROUND

The usefulness of ultrasound-guided techniques for radial arterial catheterisation has been well identified; however, its usefulness has not been completely evaluated in infants under 12 months of age, who are generally considered the most difficult group for arterial catheterisation.

OBJECTIVE

We evaluated whether ultrasound guidance would improve success rates and reduce the number of attempts at radial arterial catheterisation in infants.

DESIGN

A randomised, controlled and patient-blinded study.

SETTING

Single-centre trial, study period from June 2016 to February 2017.

PATIENTS

Seventy-four infants undergoing elective cardiac surgery.

INTERVENTION

Patients were allocated randomly into either ultrasound-guided group (group US) or palpation-guided group (group P) (each n=37) according to the technique applied for radial arterial catheterisation. All arterial catheterisations were performed by one of two experienced anaesthesiologists based on group assignment and were recorded on video.

MAIN OUTCOME MEASURES

The primary endpoint was the first-pass success. The number of attempts and total duration of the procedure until successful catheterisation were also analysed.

RESULTS

The first-pass success rate was significantly higher in the group US than in the group P (68 vs. 38%, P = 0.019). In addition, fewer attempts were needed for successful catheterisation in the group US than in the group P (median 1 [IQR 1 to 2] vs. 2 [1 to 4], P = 0.023). However, the median [IQR] procedural time (s) until successful catheterisation in the two groups was not significantly different (102 [49 to 394] vs. 218 [73 to 600], P = 0.054).

CONCLUSION

The current study demonstrated that the ultrasound-guided technique for radial arterial catheterisation in infants effectively improved first-pass success rate and also reduced the number of attempts required.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02795468.

摘要

背景

超声引导技术在桡动脉置管中的有效性已得到充分证实；然而，其在 12 个月以下婴儿中的有效性尚未完全评估，这些婴儿通常被认为是动脉置管最困难的群体。

目的

我们评估超声引导是否会提高桡动脉置管的成功率并减少尝试次数。

设计

随机、对照和患者盲法研究。

地点

单中心试验，研究时间为 2016 年 6 月至 2017 年 2 月。

患者

74 例行择期心脏手术的婴儿。

干预措施

根据桡动脉置管所应用的技术，将患者随机分配到超声引导组（US 组）或触诊引导组（P 组）（每组 n=37）。所有动脉置管均由两位经验丰富的麻醉师之一根据分组进行操作，并录像记录。

主要观察指标

主要终点是首次置管成功率。还分析了置管成功所需的尝试次数和总操作时间。

结果

US 组的首次置管成功率明显高于 P 组（68%比 38%，P=0.019）。此外，US 组成功置管所需要的尝试次数也少于 P 组（中位数 1 [IQR 1 到 2]比 2 [1 到 4]，P=0.023）。然而，两组之间成功置管所需的操作时间（秒）中位数差异无统计学意义（102 [49 到 394]比 218 [73 到 600]，P=0.054）。