中心静脉导管行股动脉测压在脊柱侧弯矫形术中安全性和有效性研究

发布时间：2018-04-19 20:35

本文选题：脊柱侧弯矫形术 + 动脉压　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]探讨在脊柱侧弯矫形术中,使用小儿中心静脉导管进行股动脉穿刺置管测量有创动脉血压的安全性和有效性。[方法]选择从2015年8月至2016年10月期间在昆明医科大学第二附属医院拟行脊柱侧弯矫形术的患者24例,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ～Ⅱ级。患者均采用静脉快诱导方法,并在气管插管静吸复合全身麻醉下实施手术。诱导插管完成后,将患者随机分为A组和B组,每组各12人。A组病人使用动脉穿刺针行桡动脉穿刺置管,并用单腔中心静脉导管行股动脉穿刺置管,分别连接进口动脉压力转换器与监护仪并测量桡动脉和股动脉的动脉血压;B组病人单纯用动脉穿刺针进行桡动脉置管测桡动脉动脉血压。依次选取手术开始前(T1)、矫形开始时(T2)、出血量较大时(T3)、术中清醒试验时(T4)、术毕清醒试验时(T5)、进入重症监护病房(IntensiveCareUnit,ICU)时(T6)、进入 ICU 后 6 小时(T7)、进入 ICU 后12小时(T8)8个时间点,分别记录桡动脉和/或股动脉收缩压(Systolic Arterial Pressure,SAP)、舒张压(Diastolic Arterial Pressure,DAP)和平均动脉压(Mean Arterial Pressure,MAP)、心率(Heart Rate,HR)等。此外,观察并记录桡动脉及股动脉置管是否出现以下相关并发症及例数:(1)术前穿刺置管困难、动脉痉挛;(2)麻醉过程中及在ICU监护过程中发生导管打折或脱出、穿刺置管处远端肢体血液循环障碍(尤其是A组股动脉穿刺侧下肢是否出现下肢青紫、浮肿等);(3)拔除导管后穿刺部位出现血肿及渗血;(4)一周后随访穿刺部位发生术后感染及例数。将收集来的A组桡动脉和股动脉的收缩压、舒张压、平均动脉压压力值进行组内比较,并对A组和B组的桡动脉和股动脉收缩压、舒张压、平均动脉压的压力值以及A、B两组的心率进行组间比较。统计并比较两组桡动脉和股动脉置管发生术前置管困难、动脉痉挛,术中及术后在ICU发生导管打折及脱出、穿刺侧下肢循环障碍,拔除导管后出现渗血、血肿和穿刺部位感染等并发症的例数和发生率。[结果]两组病人的一般情况:年龄、身高、体重和手术时间经比较差异无统计学意义(P0.05);A组各个时期桡动脉和股动脉SAP、DAP和MAP的压力值自身比较差异无统计学意义(P0.05);A组股动脉和B组桡动脉各个时期SAP、DAP和MAP的压力差值差异无统计学意义(P0.05);A、B两组心率各个时期比较差异无统计学意义(P0.05)。A、B两组共24例患者均进行了桡动脉穿刺置管测压:(1)发生术前桡动脉穿刺置管困难4例(16.7%),其中A、B组各2例;发生动脉痉挛1例(A组)(4.2%)。(2)发生桡动脉导管打折5例(20.8%),其中A组3例(术中2例,进入ICU后1例),B组2例(均发生在术中);发生桡动脉导管脱出2例(2.3%),其中A、B组各1例(均发生在术中)。(3)拔除桡动脉置管后,发现局部小血肿3例(12.5%),其中A组1例,B组2例;出现渗血2例(8.3%),其中A、B组各1例。A组行中心静脉导管股动脉穿刺测血压的12名患者术前、术中和进入ICU监护过程中均未出现明显并发症,拔除中心静脉导管后,出现1例局部小血肿(8.3%),发现1例穿刺部位的渗血(8.3%)。桡动脉置管和股动脉置管测血压的患者均未发现术中及进入ICU监护中穿刺处远端肢体血液循环障碍;在拔管后均未发现需要外科处理的大血肿,一周随访均未发现与动脉置管相关的感染。[结论](1)脊柱侧弯矫形术中使用中心静脉导管行股动脉置管测压与桡动脉置管测压在各个时段测量得出的动脉血压是一致的。(2)脊柱侧弯矫形术中使用中心静脉导管行股动脉置管测压与桡动脉置管测压相比,发生导管打折脱出及局部血肿的可能性更低,穿刺成功率更高,因而具有更高的安全性。
[Abstract]:[Objective] to explore the safety and effectiveness of using the central venous catheterization of the femoral artery to measure the blood pressure of the invasive artery in the scoliosis orthopedics. [Methods] 24 cases of scoliosis correction in the Second Affiliated Hospital of Kunming Medical University from August 2015 to October 2016 were selected, and the association of Anesthesiologists in the United States. The patients were graded (American Society of Anesthesiologists, ASA) grade I to II. The patients were treated with the method of intravenous rapid induction, and the operation was performed under the tracheal intubation combined with general anesthesia. After the intubation was completed, the patients were randomly divided into A group and B group. Each group of 12.A patients made the radial artery puncture tube with the artery puncture needle and used the single cavity. The central venous catheter was performed by femoral artery puncture and catheterization, respectively connecting the imported arterial pressure converter and the monitor and measuring the arterial blood pressure of the radial artery and the femoral artery. The patients in group B were simply using the artery puncture needle for the radial artery to measure the blood pressure of the radial artery. In turn, the patients were selected before the operation (T1), the orthopedics began (T2), and the amount of bleeding was larger (T3). T4, T5, IntensiveCareUnit, ICU (T6), 6 hours after ICU (T7), and 8 hours after ICU 12 hours (T8), and the systolic pressure of the radial artery and / or the femoral artery (Systolic Arterial Pressure), and the diastolic pressure were recorded. Mean Arterial Pressure (MAP), heart rate (Heart Rate, HR) and so on. In addition, the following related complications and cases of the radial and femoral artery catheterization were observed and recorded: (1) preoperative puncture and catheterization difficulty, arterial spasm; (2) during the anesthesia process and during ICU monitoring, catheter discounts or release, and the distal limb blood in the puncture and catheterization (3) hematoma and osmotic blood in the puncture site after the extraction of the catheter in group A, especially in the femoral artery puncture on the side of the femoral artery; (4) the postoperative infection and the number of cases after the puncture were followed up. The systolic pressure, diastolic pressure, and mean arterial pressure pressure of the radial and femoral arteries in group A were collected. Compare the radial and femoral artery systolic pressure, diastolic pressure, average pressure of arterial pressure, and heart rate of A, B two groups in group A and group B, and compare the difficulties of the two groups of radial and femoral artery catheterization, arterial spasm, intraoperative and postoperative ICU catheter discounts and release, and the puncture side of the lower limbs. The number and incidence of complications such as infiltration of blood, hematoma and puncture site infection after the removal of catheterization. [results] the general situation of two groups of patients: age, height, weight and operation time were not statistically significant (P0.05), and there was no statistical difference between the pressure values of SAP, DAP and MAP in the radial and femoral arteries at each period of A. Significance (P0.05); there was no significant difference in the difference of pressure between SAP, DAP and MAP at each period of radial artery in group A and group B (P0.05); A, B two groups had no statistically significant difference in each period of heart rate (P0.05).A, and 24 patients in the two group of B were measured by radial artery puncture catheterization: (1) 4 cases (16.7%) had difficulty in puncture and catheterization before operation. Among them, there were 2 cases in group A, 1 cases of arterial spasm (group A) (4.2%). (2) 5 cases of radial artery catheterization (20.8%), of which 3 cases in group A (2 in the operation, 1 after ICU), 2 in group B (all in the operation) and 2 (2.3%) of radial artery catheterization (2.3%) in group A and B (all occurred during the operation). (3) after removal of the radial artery catheterization, the local small hematoma was found. Cases (12.5%), of which 1 cases in group A and 2 cases in group B and 2 cases of hemoootic (8.3%), of which 12 patients in group A, group B and 12 group of.A in group B had no obvious complications during and during ICU monitoring, and there were 1 local hematoma (8.3%) after the removal of central venous catheter, and 1 cases of puncture site were found. Blood (8.3%). The patients with radial artery catheterization and femoral artery catheterization were not found in the intraoperative and ICU monitoring of the distal limb blood circulation disorders; after extubation, no large hematoma needed surgical treatment was found, and no artery catheterization related to the arterial catheterization was found in one week. [Conclusion] (1) the use of the center in the orthopedic operation of the scoliosis The arterial pressure measured by the femoral artery catheterization and the radial artery catheterization were the same. (2) the use of the central venous catheter in the scoliosis was less likely to be discounted and local hematoma than the radial artery catheterization, and the success rate of the puncture was higher. High, and thus has higher security.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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