危重儿童不同部位动脉置管的临床疗效比较
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摘要
目的探讨危重患儿分别以桡动脉、足动脉、腋动脉为穿刺部位在监测有创血压的效果对比,为儿童寻找最佳动脉导管留置部位。方法收集2017年1月-2018年8月该院儿童重症监护室(PICU)的142例动脉穿刺置管患儿,随机分为桡动脉组、足背动脉组和腋动脉组。其中桡动脉组70例,足背动脉组42例,腋动脉组30例。比较三组患儿的动脉穿刺置管成功率、置管留置时间和置管部位形成瘀斑例数。结果桡动脉组、足背动脉组和腋动脉组一次性置管成功率分别为91.4%、73.8%和70.0%,桡动脉组与其他两组相比,差异均有统计学意义。腋动脉组置管留置时间最长为(3.6±0.9)天,但同时腋动脉组留置部位瘀斑形成的人数比例最高(26.7%),明显高于桡动脉组(4.3%)和足背动脉组(7.1%)。结论在危重患儿动脉穿刺置管中,桡动脉穿刺部位的一次性置管成功率最高;腋动脉穿刺部位的置管留置时间最长,但该置管部位形成瘀斑的人数比例也最高。
【Objective】To investigate the effect of monitoring the invasive blood pressure in critically ill children with radial artery, foot artery and axillary artery as puncture sites, and expected to obtain the best arterial catheter indwelling site in children.【Methods】From January 2017 to August 2018, 142 children in the Pediatric Intensive Care Unit(PICU) of our hospital were enrolled due to the critical condition. The patients with dynamic blood pressure monitoring were automatically determined by arterial catheterization. They were automatically divided into radial artery group, dorsal artery group and axillary artery group with the most sure and successful arterial catheterization. There were 70 cases in radial artery group, 42 cases in dorsal artery group and 30 cases in axillary artery group. The number of cases of arterial puncture catheter success rate, catheter indwelling time, and ecchymosis at the catheterization site were observed in the three groups.【Results】The success rate of one-time placement of the radial artery group, the dorsal artery group and the axillary artery group was 91.4%, 73.8% and 70.0%, respectively. `The difference between the radial artery group and the other two groups was statistically significant. From the point of view of the indwelling time of the arterial catheter, the time of indwelling in the axillary artery group was the longest, which was(3.6 ± 0.9) days, but the proportion of the erythema in the indwelling part of the axillary artery group was also the highest, accounting for 26.7% of the group, significantly higher than the radial artery group(4.3%) and the dorsal artery group(7.1%).【Conclusion】In critically ill children requiring arterial catheterization, the success rate of the radial artery catheterization is the highest; the site with the longest indwelling time of the arterial catheter is in the axillary artery, but at the same time the proportion of people with ecchymoses is also the highest in this group.
【Objective】To investigate the effect of monitoring the invasive blood pressure in critically ill children with radial artery, foot artery and axillary artery as puncture sites, and expected to obtain the best arterial catheter indwelling site in children.【Methods】From January 2017 to August 2018, 142 children in the Pediatric Intensive Care Unit(PICU) of our hospital were enrolled due to the critical condition. The patients with dynamic blood pressure monitoring were automatically determined by arterial catheterization. They were automatically divided into radial artery group, dorsal artery group and axillary artery group with the most sure and successful arterial catheterization. There were 70 cases in radial artery group, 42 cases in dorsal artery group and 30 cases in axillary artery group. The number of cases of arterial puncture catheter success rate, catheter indwelling time, and ecchymosis at the catheterization site were observed in the three groups.【Results】The success rate of one-time placement of the radial artery group, the dorsal artery group and the axillary artery group was 91.4%, 73.8% and 70.0%, respectively. `The difference between the radial artery group and the other two groups was statistically significant. From the point of view of the indwelling time of the arterial catheter, the time of indwelling in the axillary artery group was the longest, which was(3.6 ± 0.9) days, but the proportion of the erythema in the indwelling part of the axillary artery group was also the highest, accounting for 26.7% of the group, significantly higher than the radial artery group(4.3%) and the dorsal artery group(7.1%).【Conclusion】In critically ill children requiring arterial catheterization, the success rate of the radial artery catheterization is the highest; the site with the longest indwelling time of the arterial catheter is in the axillary artery, but at the same time the proportion of people with ecchymoses is also the highest in this group.
引文
[1]许月春,邹国锦,张群,等.动脉置管处改良采血法检测血气分析与APTT的可行性研究[J].护理学杂志, 2012, 27(15):7-8.
[2]姜翠,周丽英,赵艳华.有创动脉血压监测在危重新生儿中的应用效果及护理[J].全科护理, 2017, 15(21):2629-2631.
[3]Bobbia,X,GrandpierreRG,ClaretPG,etal.Ultrasound guidance for radial arterial puncture:a randomized controlled trial[J]. Am J Emerg Med, 2013, 31(5):810-815.
[4]Tong Z, Gu Y, Guo L, et al. An analysis of complications of brachial and axillary artery punctures[J]. Am Surg, 2016, 82(12):1250-1256.
[5]Fairley SL, Lucking AJ, McEntegart M, et al. Routine use of fluoroscopic-guided femoral arterial puncture to minimise vascular complication rates in CTO intervention:multi-centre UK experience[J]. Heart Lung Circ, 2016, 25(12):1203-1209.
[6]De Oliveira GS Jr, Beckmann K, Salvacion A, et al. The effect of the arterial catheter insertion technique on the success of radial artery cannulation:a prospective and randomized study[J]. J Crit Care, 2014, 29(3):475.e7-475.e10.
[7]Rao SV, Stone GW. Arterial access and arteriotomy site closure devices[J]. Nat Rev Cardiol, 2016, 13(11):641-650.
[8]Sandoval Y, Burke MN, Lobo AS, et al. Contemporary arterial accessinthecardiaccatheterizationlaboratory[J].JACC Cardiovasc Interv, 2017, 10(22):2233-2241.
[9]Wright SP, Opotowsky AR, Buchan TA, et al. Flow-related right ventricular to pulmonary arterial pressure gradients during exercise[J]. Cardiovasc Res, 2018, 115(1):222-229.
[2]姜翠,周丽英,赵艳华.有创动脉血压监测在危重新生儿中的应用效果及护理[J].全科护理, 2017, 15(21):2629-2631.
[3]Bobbia,X,GrandpierreRG,ClaretPG,etal.Ultrasound guidance for radial arterial puncture:a randomized controlled trial[J]. Am J Emerg Med, 2013, 31(5):810-815.
[4]Tong Z, Gu Y, Guo L, et al. An analysis of complications of brachial and axillary artery punctures[J]. Am Surg, 2016, 82(12):1250-1256.
[5]Fairley SL, Lucking AJ, McEntegart M, et al. Routine use of fluoroscopic-guided femoral arterial puncture to minimise vascular complication rates in CTO intervention:multi-centre UK experience[J]. Heart Lung Circ, 2016, 25(12):1203-1209.
[6]De Oliveira GS Jr, Beckmann K, Salvacion A, et al. The effect of the arterial catheter insertion technique on the success of radial artery cannulation:a prospective and randomized study[J]. J Crit Care, 2014, 29(3):475.e7-475.e10.
[7]Rao SV, Stone GW. Arterial access and arteriotomy site closure devices[J]. Nat Rev Cardiol, 2016, 13(11):641-650.
[8]Sandoval Y, Burke MN, Lobo AS, et al. Contemporary arterial accessinthecardiaccatheterizationlaboratory[J].JACC Cardiovasc Interv, 2017, 10(22):2233-2241.
[9]Wright SP, Opotowsky AR, Buchan TA, et al. Flow-related right ventricular to pulmonary arterial pressure gradients during exercise[J]. Cardiovasc Res, 2018, 115(1):222-229.