新桡动脉定位下不同角度穿刺对新生儿采血的应用价值  

Novel visual observation localization method in collecting blood sample via radial artery puncturing for neonate:at different angles

作　　者：任月红[1] 郭佳堂 张洁[1] 李宁 张樊[1] 张凤 王伟 REN Yuehong;GUO Jiatang;ZHANG Jie(Neonatal Department,Baoding Maternal and Child Health Hospital,Hebei,Baoding 071000,China;不详)

机构地区：[1]河北省保定市妇幼保健院新生儿科,071000 [2]陆军第八十二集团军医院手术室

出　　处：《河北医药》2022年第24期3734-3737,共4页Hebei Medical Journal

基　　金：保定市科技计划项目(编号:1941ZF070)。

摘　　要：目的探索新桡动脉定位下不同角度穿刺应用于新生儿采血的不同结局,得出结论和制定标准化流程,用于指导临床,服务于广大患儿。方法选取保定市妇幼保健院新生儿科于2019年5~10月收治的新生儿病例患者371例作为研究对象,按体重(新生儿体重计算公式)大小将其分成体重≤1.0 kg组、1.0 kg<体重≤1.5 kg组、1.5 kg<体重≤2.5 kg组、2.5 kg<体重≤3.5 kg组、体重>3.5 kg组。穿刺针尖与皮肤分别呈10°~15°、15°~20°、20°~30°、30°~40°、40°~60°采血操作者均按统一的桡动脉定位法(新目测定位法)采集并记录一次性穿刺成功率、未拔针试穿成功率、疼痛评分[新生儿面部编码系统(NFCS)、操作性疼痛(NIPS)、啼哭率]。结果体重>3.5 kg组一次性穿刺成功率显著高于其他4组,未拔针试穿成功率、失败率显著低于其他4组,差异均有统计学意义(P<0.05)。体重>3.5 kg组穿刺结束时的NFCS、NIPS评分均低于其他4组,心率上升幅度较其他4组偏低,差异均有统计学意义(P<0.05)。体重>3.5 kg组啼哭率显著低于其他4组,不啼哭率高于其他4组,差异均有统计学意义(P<0.05)。新桡动脉定位法的预测相关系数较传统定位法更低,有效的降低了测量误差,准确性较高(r=0.9012,EMSE=0.8956%)。新生儿桡动脉穿刺角度的大小与新生儿体重呈正相关,体重越大,桡动脉穿刺角度越大。结论新桡动脉定位法可有效降低测量误差,准确性高,且新生儿体重与桡动脉采血穿刺角度关系密切。Objective To Compare the outcomes of novel visual observation localization method in collecting blood sample via radial artery puncturing for neonate at different angles for a standardized process guiding clinical practices and serving neonate.Methods Neonates(n=371)admitted to the Neonatology Department,Baoding Maternal and Child Health Hospital from May 2019 to October 2019 were as the subjects,the neonates were enrolled into the weight(WT)≤1.0kg group,1.0kg3.5kg group.The needle tip for puncturing formed the 10°~15°,15°~20°,20°~30°,30°~40°and 40°~60°respectively.Novel visual observation localization method was conducted by blood sampling operators for collection blood sample via radial artery puncturing for neonate.The one-time puncture success rate,unplanned extubation rate,pain score[neonatal facial coding system(NFCS),neonatal infant pain scale(NIPS)],crying rate were included as comparators.Results The one-time puncture success rate in the WT>3.5kg group was significantly higher than that in the other four groups,unplanned extubation rate were significantly lower than those in the other four groups(P<0.05).The scores of NFCS and NIPS in the WT>3.5kg group at the end of puncturing were lower than those in the other four groups,and the rising range of heart rate(HR)in the WT>3.5kg group was significantly lower than that in other four groups(P<0.05).The crying rate and non-crying rate in the WT>3.5kg group were significantly superior to those in other four groups(P<0.05).The prediction correlation coefficient of the neonatal radial artery positioning method was lower than that of the traditional positioning method,effectively reducing the measurement error and exhibiting higher accuracy(r=0.9012,EMSE=0.8956%).The size of radial artery puncture angle of neonate was positively correlated with neonate weight,the radial artery puncture angle was greater with increasing weight.Conclusion Novel visual observation localization method is capable of effectively reducing the measurement error and exhibiting

关 键 词：新生儿体重 桡动脉 采血穿刺角度 相关性 

分 类 号：R473.72[医药卫生—护理学]