超声引导下动态针尖定位技术和单纯触诊在成人外科手术患者桡动脉置管中的比较：一项随机对照试验
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Ultrasound-Guided Dynamic Needle Tip Positioning Technique Versus Palpation Technique for Radial Arterial Cannulation in Adult Surgical Patients: A Randomized Controlled Trial.
背景与目的
桡动脉穿刺置管术最常用的是触诊，但超声的使用增加了置管成功率。这一进步，虽然意义重大，却没有带来非常高的成功率，特别是在培训学员中。一种用于血管置管的改良超声技术（动态针尖定位）已被报道用于外周静脉置管。因此我们在成人外科患者桡动脉置管中对这项技术和触诊的成功率进行了比较。
方 法
我们纳入了需要术中桡动脉导管置管监测的非急诊手术患者，患者被随机分为触诊组或动态针尖定位组。由住院医师或教员进行动脉置管。主要事件终点是首次置管成功，次要事件终点是5分钟成功率和5分钟内的尝试次数。
结 果
我们对260例患者进行了评价。动态针尖定位技术组(n = 132)首次成功率为83%，触诊组（n = 128;）为48%（P < 0.001）；相对危险度为2.5；95%置信区间为1.7~3.6。动态针尖定位技术组5分钟的成功率为89%，触诊组为65%（(P <0 .001），相对危险度为2.4；95%置信区间为1.2-1.6。触诊组皮肤穿刺次数明显增多（P <0 .001）。置管时间中位术和四分位数范围在动态针尖定位组为81.5 (61-122)秒，在触诊组76 (48-175) 秒（P =0 .7）。
结 论
在麻醉住院医师和教员中，与触诊相比，采用超声引导的动态针尖定位技术提高了首次成功率和总体成功率。
原始文献摘要
Kiberenge RK, Ueda K, Rosauer B；Ultrasound-Guided Dynamic Needle Tip Positioning Technique Versus Palpation Technique for Radial Arterial Cannulation in Adult Surgical Patients: A Randomized Controlled Trial；Anesth Analg. 2018 Jan;126(1):120-126. doi: 10.1213/ANE.0000000000002261.
BACKGROUND:Radial arterial cannulation is most commonly done using palpation, but the use of ultrasound has increased the cannulation success rate. This improvement, albeit significant, has not led to a very high success rate especially in trainees. A modified ultrasound technique for vascular cannulation (dynamic needle tip positioning) has been described for peripheral venous cannulation. We therefore assessed the success rate of this technique compared to the palpation technique for radial artery cannulation in adult surgical patients.
METHODS:We enrolled patients who were having nonemergent operations that required a radial arterial catheter for intraoperative monitoring. Patients were randomized to either palpation or dynamic needle tip positioning technique. Arterial cannulation was performed by anesthesia residents or faculty members. The primary end point was successful cannulation on the first pass. Secondary end points were overall 5-minute success rate and number of attempts within 5 minutes.
RESULTS:Two hundred sixty patients were evaluated. The first-pass success rate was 83% in the dynamic needle tip positioning technique group (n = 132) and 48% in the palpation group (n = 128; P < .001); relative risk was 2.5; 95% confidence interval, 1.7-3.6. The overall 5-minute success rate was 89% in the dynamic needle tip positioning technique group compared to 65% in the palpation group (P < .001), relative risk was 2.4; 95% confidence interval, 1.2-1.6. The number of skin puncture attempts was significantly more in the palpation group (P < .001). The median cannulation times and interquartile ranges were 81.5 (61-122) seconds in the dynamic needle tip positioning and 76 (48-175) seconds (P = .7) in the palpation group.
CONCLUSIONS:The use of the ultrasound-guided dynamic needle tip positioning technique increased the first and overall success rates compared to palpation in anesthesia residents and faculty members.
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