超声引导改良动态针尖追踪法行桡动脉穿刺置管术在婴幼儿病人中的应用  

Application of ultrasound-guided modified dynamic needle tip positioning technique in radial artery catheterization in infant patients

作　　者：聂彬[1] 江辉[1] 谭娟 NIE Bin;JIANG Hui;TAN Juan(Department of Anesthesiology,TongjiHospital,Tongji MedicalCollege,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉科,武汉430030

出　　处：《临床外科杂志》2023年第3期290-293,共4页Journal of Clinical Surgery

摘　　要：目的探讨并评价超声引导改良动态针尖追踪(dynamic needle tip positioning,DNTP)法在婴幼儿动脉穿刺置管术中的可行性。方法2022年6月~2022年11月收治的年龄为1~36个月、需行动脉穿刺置管的手术患儿60例,随机分为动态针尖追踪组,即DNTP组(D组)和改良DNTP组(G组)两组,每组各30例。两组患儿操作前均用超声测量桡动脉深度,D组选择桡动脉深度<2mm处作为穿刺点,改良G组在超声引导下,经皮下注射适量生理盐水将较浅的桡动脉深度增加至2~4mm后再穿刺。分别记录两组穿刺的操作时间,再比较两组首次穿刺成功率、总成功率、首次穿刺成功时间、总穿刺时间及血肿发生率。结果G组首次穿刺成功率为90.0%,总成功率为96.7%,D组首次穿刺成功率为66.7%,总成功率为80.0%,两组比较差异有统计学意义(P<0.05)。G组首次成功时间为(135.2±12.2)秒,总穿刺时间为(165.3±38.5)秒,D组分别为(227.4±23.3)秒、(258.3±45.1)秒,两组比较差异有统计学意义(P<0.05)。G组有1例发生局部血肿致桡动脉穿刺失败,D组有6例发生血管痉挛、局部血肿致桡动脉穿刺失败,两组间比较差异有统计学意义(P<0.05),经更换穿刺部位后超声引导穿刺成功。结论在婴幼儿病人桡动脉穿刺置管时,超声引导下通过皮下注射生理盐水的改良动态针尖追踪技术,可提高穿刺的成功率,缩短穿刺时间,减少穿刺相关并发症。Objective To explore and evaluate the feasibility of ultrasound-guided improved dynamic needle tip positioning(DNTP)in infant arterial catheterization.Methods A total of 60 children aged from 1 month to 36 months who were admitted to our hospital from June 2022 to November 2022 and who needed artery puncture and catheterization were selected as subjects.They were randomly divided into two groups,namely DNTP group(D group)and improved DNTP group(G group),with 30 cases in each group.The depth of the radial artery was measured by ultrasound in both groups before operation.In the DNTP group,the depth of the radial artery was less than 2 mm as the puncture point.In the improved DNTP group,the shallow radial artery depth was increased to 2-4 mm by subcutaneous injection of normal saline under the guidance of ultrasound before puncture.The operation time of the two groups were recorded respectively,and the success rate of the first puncture,the total success rate,the time of the first puncture success,the total puncture time and the incidence of hematoma were compared between the two groups.Results The success rate of first puncture was 90.0%and the total success rate was 96.7%in group G,while 66.7%and 80.0%in group D.There were statistically significant differences between the two groups(P<0.05).The first successful time of group G was(135.2±12.2)s and the total puncture time was(165.3±38.5)s,which was significantly shorter than the first successful time of group D(227.4±23.3)s and the total puncture time of group D(258.3±45.1)s,and the difference was statistically significant(P<0.05).There were 1 case of failure of radial artery puncture caused by local hematoma in group G,and 6 cases of failure of radial artery puncture caused by vasospasm and local hematoma in group D,with statistical significance between the two groups(P<0.05).Ultrasound-guided puncture was successful after changing the puncture site.Conclusion During radial artery catheterization in infants and young children,the ultrasound-guided modified dyn

关 键 词：动脉穿刺 动态针尖追踪法 婴幼儿 桡动脉深度 

分 类 号：R473.72[医药卫生—护理学]