成人患者动脉置管严重并发症的危险因素
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Surgical and Patient Risk Factors for Severe Arterial Line Complications in Adults
背景与目的
有研究表明与动脉置管并发症的危险因素相关的研究所提供的数据并不一致。本研究的目的为明确与动脉置管并发症相关的危险因素及发生率。
方 法
经机构评审委员会的批准，2006年1月1日至2012年12月31日期间，所有需要动脉置管的患者均已纳入本次回顾性研究。利用两个权威数据库：围术期数据库和梅奥诊所生命沉默系统，对发生并发症（血液系统、神经系统、感染、或30天内进行手术）患者进行交叉匹配分析，以确定并发症人数。
结 果
在57787名患者中，共置入62626根动脉导管。90.1%的导管为20号， 94.5% 的病人穿刺部位为桡动脉，共有21名患者确诊发生血管并发症或神经损伤，并发症发生率为3.4 / 10,000[95% CI, 2.1 ～ 5.1[;心脏手术患者需要动脉置管人数最多（n = 15,419），其中12名患者发生相关并发症，发生率为 7.8 / 10,000[95% CI, 4.0 ～13.6]，并发症的发生率与导管的型号有关，在三种最常见的不同型号导管（P = 0.001）中差异显着（P <0.001），并发症分别为：2.7 /10,000（20＃） 、17.2 / 10,000 （18＃）、以及9.4/10,000（16＃）。
结 论
在本次大规模回顾性研究中，作者证实了动脉导管置入并发症发生率很低。
原始文献摘要
Nuttall G, Burckhardt J, Hadley A, et al. Surgical and Patient Risk Factors for Severe Arterial Line Complications in Adults.[J]. Anesthesiology, 2015
Background: Prior research has provided inconsistent data regarding the risk factors associated with complications from arterial cannulation. The goal of this study was to clearly define the incidence and risks factors associated with arterial cannulation complications.
Methods: After obtaining institutional review board approval, all patients requiring arterial line placement with documentation were included in this retrospective study between January 1, 2006, and December 31, 2012. Leveraging two robust data warehouses, the Perioperative DataMart and the Mayo Clinic Life Silences System, the authors cross-matched arterial line
cannulation with a documented vascular consult, neurologic consult, infection, or return to surgery within 30 days in order to identify the initial patient population.
Results: A total of 62,626 arterial lines were placed in 57,787 patients, and 90.1% of the catheters placed were 20-gauge catheters. The radial artery was cannulated in 94.5% of patients. A total of 21 patients were identified as having experienced vascular complications or nerve injuries, resulting in a complication rate of 3.4 per 10,000 (95% CI, 2.1 to 5.1). Cardiac surgery had the largest number of catheters placed (n = 15,419) with 12 complications (complication rate = 7.8 per 10,000; 95% CI, 4.0 to 13.6). The rate of complications differed significantly (P < 0.001) across the three most common catheter sizes (2.7 per 10,000 [95% CI, 1.5 to 4.4] for 20 gauge, 17.2 per 10,000 [95% CI, 4.7 to 43.9] for 18 gauge, and 9.4 per 10,000[95% CI, 1.1 to 34.1] for 5 French).
Conclusion: In a large retrospective study, the authors document a very low rate of complications with arterial line placement
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