超声引导技术在老年髋部骨折患者桡动脉穿刺置管中的应用  

Application of Ultrasound Guided Technology in the Management of Arterial Puncture in Elderly Patients with Hip Fracture

作　　者：陈雪[1] 张文超[1] 王佳[1] 种皓[1] 周雁[1] 杨明辉[2] 王庚[1] CHEN Xue;ZHANG Wenchao;WANG Jia;CHONG Hao;ZHOU Yan;YANG Minghui;WANG Geng(Department of Anesthesiology,,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Traumatic Orthopedics,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院麻醉科,北京100035 [2]北京积水潭医院创伤骨科,北京100035

出　　处：《医学综述》2018年第23期4600-4604,共5页Medical Recapitulate

基　　金：北京积水潭医院青年人才培养"学科新星"计划专项(XKXX201619);北京市医院管理局重点医学专业发展计划(ZYLX201506)

摘　　要：目的比较超声引导穿刺置管短轴、长轴以及斜轴技术在老年髋部骨折患者桡动脉置管的应用效果。方法选择2017年7月至2018年2月于北京积水潭医院创伤骨科老年髋部骨折后限期手术治疗患者240例,美国麻醉医师协会分级Ⅱ～Ⅳ级,采用随机数字法分为短轴平面外穿刺组(T组)、长轴平面内穿刺组(L组)、斜轴平面内-外联合组(O组),每组80例。三组患者动脉穿刺前采用1%利多卡因局部麻醉。记录首次穿刺成功率、穿刺失败率及并发症发生情况。结果 O组穿刺置管的首次成功率显著高于T组和L组[93. 7%(75/80)比78. 8%(50/80)、62. 5%(63/80)],L组首次成功率显著低于T组(P <0. 05),T组和O组动脉置管时间显著短于L组[(27±15) s、(30±14) s比(45±17) s](P <0. 05),T组与O组动脉置管时间比较差异无统计学意义(P> 0. 05)。三组穿刺失败率以及血肿率比较差异均无统计学意义(P> 0. 05)。结论超声引导下斜轴平面内-外联合穿刺技术成功率高,操作时间短。Objective To compare the effect of ultrasound-guided puncture and insertion of short axis,long axis and oblique axis technologies on radial artery catheterization in elderly hip fracture patients.Methods240elderly patients with hip fracture gradedⅡ-Ⅳby American Society of Anesthesiologists Score who underwent limited operation in Department of Traumatic Orthopedics,Beijing Jishuitan Hospital from Jul.2017to Feb.2018were included in the study.The patients were divided into a transverse puncture group(group T),a long-axis intraplanar puncture group(group L)and oblique-axis intraplanar-extraplanar puncture group(group O),80cases in each group.All of the three groups received local anesthesia with1%lidocaine before arterial puncture.The success rate of first puncture,the failure rate of puncture and the incidence of complications were recorded.Results The success rate of first puncture was significantly higher in group O than in group T and group L[93.7%(75/80)vs78.8%(50/80),62.5%(63/80)](P<0.05).It was significantly higher in group T than in group L(P<0.05).Time needed to cannulate the radial artery was significantly shorter in group T and group O than that in group L[(27±15)s,(30±14)s vs(45±17)s](P<0.05).There was no significant difference in arterial catheterization time between group T and group O(P>0.05).No significant difference was found in the rate of puncture failure and the rate of hematoma in the three groups(P>0.05).Conclusion Oblique approach for ultrasound-guided radial artery catheterization has higher success rate and shorter operation time.

关 键 词：髋部骨折 老年 超声引导 桡动脉 置管 超声斜轴技术 

分 类 号：R643.4[医药卫生—外科学]