皮下注射硝酸甘油用于小儿患者桡动脉置管
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Subcutaneous Nitroglycerin for Radial Arterial Catheterization in Pediatric Patients: A Randomized Controlled Trial
背景与目的
由于血管较小，小儿桡动脉置管具有挑战性。硝酸甘油是一种有效的血管扩张剂，可通过增加桡动脉内径和防止成年患者的血管痉挛来增加桡动脉置管的成功率。本研究旨在验证一假设，即皮下注射硝酸甘油可提高小儿桡动脉置管的成功率。
方 法
这项双盲、随机、对照、单中心研究纳入了在全麻期间需要桡动脉置管的小儿患者(n=113，年龄小于2岁)。将其随机分为硝酸甘油组(n=57)和对照组(n=56)。全身麻醉诱导后，在超声引导下于所选桡动脉上方皮下注射硝酸甘油溶液(5μg/kg的硝酸甘油0.5ml)或生理盐水(0.5ml)，注射时间大于10s。3min后在超声引导下行桡动脉置管。分别在皮下注射硝酸甘油前后和置管后测量桡动脉内径。主要观察指标是首次置管成功率。次要观察指标包括桡动脉内径和包括血肿和血管痉挛在内的总体并发症的发生率。
结 论
小儿桡动脉置管前皮下注射硝酸甘油不仅可提高首次置管成功率，还可降低总体并发症发生率。
原始文献摘要
Jang YE, Ji SH, Kim EH, et al. Subcutaneous Nitroglycerin for Radial Arterial Catheterization in Pediatric Patients: A Randomized Controlled Trial[J]. Anesthesiology, 2020, undefined: undefined.
BACKGROUND:Pediatric radial artery cannulation is challenging because of the small vessel size. Nitroglycerin is a potent vasodilator and facilitates radial artery cannulation by increasing the internal diameter and preventing the vasospasm in adult patients. The authors hypothesize that subcutaneous nitroglycerin injection will improve the success rate of pediatric radial artery cannulation.
METHODS:This double-blind, randomized, controlled, single-center study enrolled pediatric patients (n = 113, age less than 2 yr) requiring radial artery cannulation during general anesthesia. The participants were randomized into the nitroglycerin group (n = 57) or control group (n = 56). After inducing general anesthesia, nitroglycerin solution (5 μg/kg in 0.5 ml), or normal saline (0.5 ml) was subcutaneously injected above the chosen radial artery over 10 s with ultrasound guidance. Three minutes later, the ultrasound-guided radial artery cannulation was performed. Radial artery diameter was measured before and after the subcutaneous injection and after cannulation. The primary outcome was the first-attempt successful cannulation rate. The secondary outcomes included the diameter of the radial artery and the overall complication rate including hematoma and vasospasm.
RESULTS:A total of 113 children were included in the analysis. The nitroglycerin group had a higher first-attempt success rate than the control group (91.2% [52 of 57] vs. 66.1% [37 of 56]; P = 0.002; odds ratio, 5.3; 95% CI, 1.83 to 15.6; absolute risk reduction, -25.2%; 95% CI, -39.6 to -10.7%). Subcutaneous nitroglycerin injection increased the diameter of the radial artery greater than normal saline (25.0 ± 19.5% vs. 1.9 ± 13.1%; 95% CI of mean difference, 16.9 to 29.3%; P<0.001). Overall complication rate was lower in the nitroglycerin group than in the control group (3.5% [2 of 57] vs. 31.2% [18 of 56]; P = 0.001; odds ratio, 0.077; 95% CI, 0.017 to 0.350; absolute risk reduction, 28.6%; 95% CI, 15.5 to 41.8%).
CONCLUSIONS:Subcutaneous nitroglycerin injection before radial artery cannulation improved the first-attempt success rate and reduced the overall complication rates in pediatric patients.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：何幼芹 编辑：冯玉蓉 审校：王贵龙