Baker R J, Chunprapaph B, Nyhus L M
Surgery. 1976 Oct;80(4):449-57.
Percutaneous radial artery catheterization for blood gas monitoring and continuous arterial pressure recording has become a common place procedure in the management of critically ill patients. Five patients with severe ischemia after cannulation have been encountered in the past 20 months, four of whom lost segments of one or more digits. Review of the events preceding and during radial artery cannulation allowed elucidation of the following principles: radial artery catheterization should be preceded always by a negative Allen test; the catheter should be removed after 12 to 18 hours, especially if the patient is critically ill, is hypercoagulable, or has impaired tissue perfusion; the superficial temporal artery is safer to use and permits long-term cannulation (5 to 7 days) without ill effect; and agressive approach to assessing flow and arterial reconstruction is essential if severe ischemic symptoms occur during or after radial artery catheterization. Ancillary measures, including cervicodorsal sympathetic block, intravenous low molecular weight dextran and heparin, and intra-arterial reserpine and fibrinolysin, may improve palmar circulation but should not be substituted for both noninvasive and angiographic study of arterial flow, followed by surgical restoration of flow, when indicated.
经皮桡动脉插管用于血气监测和连续动脉压记录已成为危重症患者管理中的常见操作。在过去20个月里，遇到了5例插管后出现严重缺血的患者，其中4例患者一个或多个手指节段坏死。回顾桡动脉插管前后的事件，明确了以下原则：桡动脉插管前应始终进行Allen试验阴性；导管应在12至18小时后拔除，尤其是患者病情危重、具有高凝状态或组织灌注受损时；颞浅动脉使用更安全，可长期插管（5至7天）且无不良影响；如果在桡动脉插管期间或之后出现严重缺血症状，积极评估血流并进行动脉重建至关重要。辅助措施，包括颈背交感神经阻滞、静脉注射低分子右旋糖酐和肝素、动脉内注射利血平和纤维蛋白溶酶，可能改善手掌循环，但不应替代对动脉血流的无创和血管造影研究，必要时应进行手术恢复血流。
