目的:探讨鼻烟壶动脉压测量在常规择期手术患者麻醉中的可行性。
方法:进行前瞻性随机对照试验。纳入2020年6月1日至2022年6月1日在邯郸市中医院接受择期手术的患者。需测量动脉压进行血流动力学监测的患者在知情同意的情况下随机分为常规桡动脉穿刺组和鼻烟罐动脉穿刺组。常规桡动脉穿刺组患者在患者桡骨茎突处放置导管测量压力。鼻烟壶动脉穿刺组中,鼻烟罐动脉,那是,手背上的桡骨窝(鼻烟壶),选择鼻烟壶进行动脉穿刺和置管进行压力测量。动脉穿刺导管的留置时间,动脉血压,观察两组患者穿刺置管并发症发生情况。采用多因素Logistic回归分析筛选影响动脉插管结果的相关因素。
结果:最后,共纳入252例患者,其中130例患者接受常规桡动脉穿刺,122例患者接受鼻烟壶动脉穿刺。性别、年龄,体重指数(BMI),两组患者的手术类型。常规桡动脉穿刺组与鼻烟壶动脉穿刺组动脉穿刺导管留置时间差异无统计学意义(分钟:3.4±0.3vs.3.6±0.3,P>0.05)。鼻烟壶动脉穿刺组测得的收缩压(SBP)和舒张压(DBP)明显高于常规桡动脉穿刺组[SBP(mmHg,1mmHg≈0.133kPa):162.3±14.3vs.156.6±12.5,DBP(mmHg):85.3±12.6vs.82.9±11.3,均P<0.05。动脉痉挛等并发症的发生率无统计学差异,动脉闭塞,两组之间的假性动脉瘤形成。然而,鼻烟壶动脉穿刺组血肿形成发生率明显低于常规桡动脉穿刺组(2.5%vs.4.6%,P<0.05)。基于动脉穿刺的难度,多因素Logistic回归分析显示,性别[优势比(OR)=0.643,95%置信区间(95CI)为0.525~0.967],年龄(OR=2.481,95CI为1.442~4.268)和BMI(OR=0.786,95CI为0.570~0.825)是影响择期手术患者麻醉期间动脉插管结果的相关因素(均P<0.05)。
结论:通过鼻烟壶动脉插管可以成为常规动脉压测量的新的可行替代方法。
OBJECTIVE: To explore the feasibility of snuff pot arterial pressure measurement for patients undergoing routine elective surgery during anesthesia.
METHODS: A prospective randomized controlled trial was conducted. Patients undergoing elective surgery admitted to the Handan Hospital of Traditional Chinese Medicine from June 1, 2020 to June 1, 2022 were enrolled. Patients who needed arterial pressure measurement for hemodynamic monitoring were randomly divided into routine radial artery puncture group and snuff pot artery puncture group with their informed consent. The patients in the routine radial artery puncture group were placed a catheter at the styloid process of the patient\'s radius to measure pressure. In the snuff pot artery puncture group, the snuff pot artery, that was, the radial fossa on the back of the hand (snuff box), was selected to conduct the snuff pot artery puncture and tube placement for pressure measurement. The indwelling time of arterial puncture catheter, arterial blood pressure, and complications of puncture catheterization of patients in the two groups were observed. Multivariate Logistic regression analysis was used to screen the relevant factors that affect the outcome of arterial catheterization.
RESULTS: Finally, a total of 252 patients were enrolled, of which 130 patients received routine radial artery puncture and 122 patients received snuff pot artery puncture. There was no statistically significant difference in general information such as gender, age, body mass index (BMI), and surgical type of patients between the two groups. There was no significant difference in the indwelling time of artery puncture catheter between the routine radial artery puncture group and the snuff pot artery puncture group (minutes: 3.4±0.3 vs. 3.6±0.3, P > 0.05). The systolic blood pressure (SBP) and the diastolic blood pressure (DBP) measured in the snuff pot artery puncture group were significantly higher than those in the conventional radial artery puncture group [SBP (mmHg, 1 mmHg ≈ 0.133 kPa): 162.3±14.3 vs. 156.6±12.5, DBP (mmHg): 85.3±12.6 vs. 82.9±11.3, both P < 0.05]. There was no statistically significant difference in the incidence of complications such as arterial spasm, arterial occlusion, and pseudoaneurysm formation between the two groups. However, the incidence of hematoma formation in the snuff pot artery puncture group was significantly lower than that in the conventional radial artery puncture group (2.5% vs. 4.6%, P < 0.05). Based on the difficulty of arterial puncture, multivariate Logistic regression analysis showed that gender [odds ratio (OR) = 0.643, 95% confidence interval (95%CI) was 0.525-0.967], age (OR = 2.481, 95%CI was 1.442-4.268) and BMI (OR = 0.786, 95%CI was 0.570-0.825) were related factors that affect the outcome of arterial catheterization during anesthesia in patients undergoing elective surgery (all P < 0.05).
CONCLUSIONS: Catheterization through the snuff pot artery can be a new and feasible alternative to conventional arterial pressure measurement.