【罂粟摘要】儿童动脉置管监测的主要短期并发症
儿童动脉置管监测的主要短期并发症
儿童围术期动脉置管是常规操作。基于临床观察股动脉路径线穿刺置管存在严重的并发症，作者展开了一项大样本的临床研究进一步评估上述并发症的情况。本研究的主要指标包括（1）围术期需要动脉置管儿童的置管部位和相关主要短期并发症。（2）按患者的置管部位和年龄描述动脉置管部位并发症的发生率。
本研究是一项单中心回顾性队列研究，作者纳入了2016年1月1日至8月15日年龄小于18岁需要手术的儿童。统计的数据包括麻醉情况，动脉置管，以及通过询问方式了解动脉置管术后30天之内的短期并发症，包括动脉置管相关的血管，神经以及感染。
4178例患者进行了5142次动脉置管。动脉置管最常见的部位是桡动脉（N=3,395 [66.0％]）和股动脉（N=1,528 [29.7％]），其中11例发生并发症：8例血管相关和3例感染（总发生率0.2％；即2/1000；95％CI，1-4），均为股动脉置管的年龄小于5岁的儿童（0.7％；即7/1000；95％CI：4-13）。大部分股动脉置管为心脏手术（91％）。婴儿和新生儿的动脉置管并发症发生率最高（分别为16/1000和11/1000；95％CI，分别为7-34和3-39）。
儿童患者用于监测的动脉置管主要并发症的总发生率较低（0.2％）。所有并发症均发生在5岁以下儿童的股动脉置管，其中婴儿和新生儿的并发症发生率最高。远端动脉置管部位（包括3000多次桡动脉置管）无并发症发生，。
翻译：易菁 编辑：佟睿 审校：曹莹
Major Short-term Complications of Arterial Cannulation for Monitoring in Children.
BACKGROUND: Perioperative arterial cannulation in children is routinely performed. Based on clinical observation of several complications related to femoral arterial lines, the authors performed a larger study to further examine complications. The authors aimed to (1) describe the use patterns and incidence of major short-term complications associated with arterial cannulation for perioperative monitoring in children, and (2) describe the rates of major complications by anatomical site and age category of the patient.
METHODS: The authors examined a retrospective cohort of pediatric patients (age less than 18 yr) undergoing surgical procedures at a single academic medical center from January 1, 2006 to August 15, 2016. Institutional databases containing anesthetic care, arterial cannulation, and postoperative complications information were queried to identify vascular, neurologic, and infectious short term complications within 30 days of arterial cannulation.
RESULTS: There were 5,142 arterial cannulations performed in 4,178 patients. The most common sites for arterial cannulation were the radial (N = 3,395 [66.0%]) and femoral arteries (N = 1,528 [29.7%]). There were 11 major complications: 8 vascular and 3 infections (overall incidence, 0.2%; rate, 2 per 1,000 lines; 95% CI, 1 to 4) and all of these complications were associated with femoral arterial lines in children younger than 5 yr old (0.7%; rate, 7 per 1,000 lines; 95% CI, 4 to 13). The majority of femoral lines were placed for cardiac procedures (91%). Infants and neonates had the greatest complication rates (16 and 11 per 1,000 lines, respectively; 95% CI, 7 to 34 and 3 to 39, respectively).
CONCLUSIONS: The overall major complication rate of arterial cannulation for monitoring purposes in children is low (0.2%). All complications occurred in femoral arterial lines in children younger than 5 yr of age, with the greatest complication rates in infants and neonates. There were no complications in distal arterial cannulation sites, including more than 3,000 radial cannulations.