超声引导下桡动脉穿刺置管的安全性和精准性研究  

A study of the safety and precision of ultrasound-guided radial artery catheterization

作　　者：沈阳[1,2] 王宏宇 魏洁[1] 陈绪军 韩流[1] SHEN Yang;WANG Hongyu;WEI Jie;CHEN Xujun;HAN Liu(Department of Anesthesiology,Perioperative and Pain Medicine,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China;Department of Anesthesiology,Nanjing Jiangning Hospital of Traditional Chinese Medicine(TCM),Nanjing 211100,China)

机构地区：[1]南京医科大学附属南京医院南京市第一医院麻醉疼痛与围术期医学科,江苏南京210006 [2]南京市江宁中医院麻醉科,江苏南京211100

出　　处：《临床超声医学杂志》2025年第4期301-306,共6页Journal of Clinical Ultrasound in Medicine

基　　金：南京市卫生科技发展专项资金项目(YKK21128)。

摘　　要：目的应用超声测量前臂桡动脉和桡神经浅支的解剖学参数,总结影响超声引导下桡动脉穿刺置管的相关解剖因素,寻找安全且精准的穿刺位置。方法选取我院拟接受全身麻醉并行有创动脉血压监测的择期手术患者100例,根据桡动脉置管位置分为A组(远端穿刺置管)33例、B组(中远端穿刺置管)34例、C组(近端穿刺置管)33例。应用超声分别测量不同位点的桡动脉横径(TDA)、桡动脉(中心)距皮肤垂直距离(VDA)、桡神经浅支相对桡动脉水平位置距离(D),并于超声引导下进行桡动脉穿刺置管。比较各组不同侧别、性别、年龄患者桡动脉和桡神经浅支相关超声参数的差异,以及各组首次穿刺置管成功率、穿刺置管时间、穿刺次数及并发症发生情况。结果①A组左右两侧TDA、D均大于B、C组,VDA小于B、C组;B组左右两侧TDA、D均大于C组,差异均有统计学意义(均P<0.001)。②各组男性患者左右两侧TDA、VDA、D均大于同组女性患者,差异均有统计学意义(均P<0.05)。③A组≥60岁患者左右两侧VDA均小于≤44岁、44~60岁患者,C组≥60岁患者左右两侧TDA均大于≤44岁、44~60岁患者,差异均有统计学意义(均P<0.05)。④A组首次穿刺置管成功率高于B、C组,穿刺次数少于B、C组,差异均有统计学意义(均P<0.05);各组穿刺置管时间比较差异无统计学意义;A组并发症发生率低于B、C组,差异均有统计学意义(均P<0.05)。结论桡动脉远端管径较粗,距皮肤最近,在桡骨茎突向近端0~5.0 cm范围内行超声引导下桡动脉穿刺置管更具安全性和精准性。Objective To measure anatomical parameters of the radial artery and superficial branch of the radial nerve(SBRN)in the forearm by ultrasound,and to summarize the relevant anatomical factors affecting ultrasound-guided radial artery catheterization,to identify a safe and precise puncture range.Methods A total of 100 elective surgery patients scheduled for general anesthesia and invasive arterial blood pressure monitoring in our hospital were enrolled.They were divided into three groups according to radial artery catheterization sites:group A(distal puncture site,33 cases),group B(mid-distal puncture site,34 cases),and group C(proximal puncture site,33 cases).The transverse diameter of the radial artery(TDA),vertical distance from the radial artery(center)to the skin(VDA),and horizontal distance between the SBRN and radial artery(D)at different site were measured by ultrasound.Radial artery catheterization was performed under ultrasound-guided.The differences in ultrasound parameters related to radial artery and SBRN among patients with different sides,genders,and age.First-attempt success rate,catheterization time,number of puncture attempts,and complications were analyzed among the groups.Results①TDA and D on the left and right sides in group A were higher than those in groups B and C,VDA was lower than that in groups B and C,and TDA and D on the left and right sides in group B were higher than those in group C,with statistical significances(all P<0.001).②The TDA,VDA and D on both sides of males in all groups were significantly higher than those in females in the same group,and the differences were statistically significant(all P<0.05).③The VDA on both sides of patients aged≥60 years in group A was lower than that of patients aged≤44 years and 44~60 years,and the TDA on both sides of patients aged≥60 years in group C was higher than that of patients aged≤44 years and 44~60 years,with statistical significances(all P<0.05).④The success rate in group A was higher than that in groups B and C,and the n

关 键 词：超声引导 桡动脉穿刺置管 穿刺位置 有创动脉血压监测 

分 类 号：R445.1[医药卫生—影像医学与核医学]