实习麻醉医生在超声引导下对新生儿桡动脉穿刺置管的新方法:一项随机对照实验
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A novel method for ultrasound-guided radial artery cannulation in neonates by trainee anaesthesiologists
背景与目的
对实习麻醉医生来说，改良的动态针尖定位(MDNTP)技术用于新生儿超声引导桡动脉穿刺置管(MDNTP-US技术)是具有挑战性的。我们假设，通过将MDNTP-US技术与皮下注射0.9%氯化钠(生理盐水MDNTP-US技术)相结合，从而增加皮下桡动脉深度，对于实习麻醉医生来说，桡动脉穿刺置管将变得更容易。比较生理盐水+MDNTP-US技术和MDNTP-US技术在新生儿桡动脉穿刺置管中的应用，并由经验有限的实习麻醉医生进行。
方 法
选取2018年5月至2018年12月期间在重庆医科大学儿童医院计划接受腹部大手术并且需要持续动脉压监测的96名新生儿。排除标准：植入部位或皮肤周围有侵蚀或血肿的新生儿以及那些无创血压值较低的新生儿。96名新生儿随机分为生理盐水+MDNTP-US组和MDNTP-US组，比例为1：1。由12名实习麻醉医生实施动脉穿刺置管术。观察指标：手术持续时间、首次尝试成功率、10分钟内成功率、血肿和血栓发生率。
结 果
生理盐水组进行穿刺置管所需时间的中位数（203s[220~600]）比MDNTP-US组(600s[220~600])短,P=0.005。生理盐水组(72.9%)10min内成功率高于对照组(47.9%),P=0.012。术后第1天，生理盐水组血肿发生率（8.3%）低于MDNTP-US组（22.9%),P=0.049。
结 论
通过使用生理盐水+MDNTP-US技术代替MDNTP-US技术对新生儿进行桡动脉穿刺置管，实习麻醉医生可以获得更高的成功率，所需时间更短，并发症发生率更低。
原始文献摘要
Ye P, Tan Y, Ye M,et，al.A novel method for ultrasound-guided radial artery cannulation in neonates by trainee anaesthesiologists [J].Eur J Anaesthesiol 2020 Feb;37(2)DOI：10.1097/EJA.0000000000001089
BACKGROUND The modified dynamic needle tip positioning (MDNTP) technique for ultrasound-guided radial artery cannu-lation (MDNTP-US technique) in neonates can be technically challenging for trainee anaesthesiologists. We hypothesised that by associating the MDNTP-US technique with hypodermic 0.9% sodium chloride (Saline MDNTP-US technique), which increases the subcutaneous radial artery depth, the procedure would become easier for trainee anaesthesiologists.
OBJECTIVE To compare the Saline MDNTP-US technique,with the MDNTP-US technique for radial artery catheterisa-tion in neonates by trainee anaesthesiologists with limited experience.
DESIGN Randomised controlled trial.
PATIENTS Ninety-six neonates scheduled to undergo major abdominal surgery requiring continuous arterial pressure monitoring between May 2018 and December 2018 at the Children’s Hospital of Chongqing Medical University were enrolled. Neonates with signs of skin erosions or haematomas at or near the insertion site, as well as those with low noninvasive blood pressure values, were excluded.
INTERVENTION Neonates were randomised to the Saline MDNTP-US and MDNTP-US groups in a 1 : 1 ratio. Twelve trainees performed the cannulation procedures.
MAIN OUTCOME MEASURES Duration of procedure, first attempt success rate, rate of success within 10 min, and the incidence of haematoma and thrombosis.
RESULTS The median [IQR] time to perform cannulation was less for the Saline MDNTP-US technique than for the MDNTP-US technique: 203 [160 to 600] vs. 600 s [220 to 600]; P¼0.005. The rate of success within 10 min, 72.9 vs.47.9%; P¼0.012, was higher in the Saline MDNTP-US group than in the MDNTP-US group. The incidence of haematoma on postoperative day 1 was lower in the Saline MDNTP-US group than in the MDNTP-US group: 8.3 vs.22.9%; P¼0.049.
CONCLUSION Trainee anaesthesiologists can achieve higher success rates by using the Saline MDNTP-US tech-nique instead of the MDNTP-US technique for radial artery catheterisation in neonates, taking less time with a lower incidence of complications.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：牛振瑛 编辑：冯玉蓉 审校：王贵龙