超声引导下桡动脉穿刺困难行血气分析：一项前瞻性、随机对照试验。
Ultrasound guidance in difficult radial artery puncture for blood gas analysis: A prospective, randomized controlled trial.
机构信息
Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, France.
Emergency Department, Timone 2 Hospital, Aix-Marseille University, Marseille, France.
出版信息
PLoS One. 2019 Mar 20;14(3):e0213683. doi: 10.1371/journal.pone.0213683. eCollection 2019.
BACKGROUND
Ultrasound (US) guidance has yet to prove its applicability in radial arterial blood gas analysis (ABGA) punctures. The main objective of our study was to compare the number of first-attempt successes (NFAS) for radial arterial puncture in difficult patients with or without US guidance. The Secondary aims were to compare the number of punctures (NOP), puncture time, and patient pain.
METHODS
In this single-center, randomized controlled trial, patients who required a radial ABGA and in whom the arterial puncture was assessed as difficult (because of non-palpable radial arteries or two previous puncture failures by a nurse) were assigned to the US group or no-US (NUS) group (procedure performed by a trained physician).
RESULTS
Thirty-six patients were included in the US group and 37 in the NUS groups. The NFAS was 7 (19%) in the NUS group and 19 (53%) in the US group. The relative risk of success in the US group was 2.79 (95% CI,1.34 to 5.82), p = 0.01. In the NUS and US groups, respectively, the median NOP was 3 [2; 6] vs. 1 [1; 2], estimated difference -2.0 (95%CI, -3.4 to -0.6), p < 0.01; the respective puncture time was 3.1 [1.6; 5.4] vs. 1.4 [0.6; 3.1] min, estimated difference -1.45 (95%CI, -2.57 to -0.39), p = 0.01; the respective median patient pain was 6 [4; 8] vs. 2 [1; 4], estimated difference -4.0 (95%CI, -5.8 to -2.3); p < 0.01.
CONCLUSION
US guidance by a trained physician significantly improves the rate of success in difficult radial ABGA patients.
背景
超声（US）引导尚未证明其在桡动脉血气分析（ABGA）穿刺中的适用性。我们研究的主要目的是比较有或没有 US 引导的情况下，桡动脉穿刺首次尝试成功（NFAS）的次数。次要目标是比较穿刺次数（NOP）、穿刺时间和患者疼痛。
方法
在这项单中心、随机对照试验中，需要进行桡动脉 ABGA 且动脉穿刺被评估为困难（由于桡动脉不可触及或护士两次穿刺失败）的患者被分配到 US 组或无 US（NUS）组（由经过培训的医生进行操作）。
结果
36 名患者被纳入 US 组，37 名患者被纳入 NUS 组。NUS 组 NFAS 为 7（19%），US 组为 19（53%）。US 组成功的相对风险为 2.79（95%CI，1.34 至 5.82），p = 0.01。在 NUS 和 US 组中，中位数 NOP 分别为 3[2;6]和 1[1;2]，估计差值-2.0（95%CI，-3.4 至-0.6），p<0.01；相应的穿刺时间分别为 3.1[1.6;5.4]和 1.4[0.6;3.1]min，估计差值-1.45（95%CI，-2.57 至-0.39），p=0.01；相应的患者疼痛中位数分别为 6[4;8]和 2[1;4]，估计差值-4.0（95%CI，-5.8 至-2.3），p<0.01。
结论
由经过培训的医生进行 US 引导可显著提高桡动脉血气分析困难患者的成功率。
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