【原】【罌粟摘要】普通外科手術中經(jīng)橈動脈穿刺置管監(jiān)測血流動力學的并發(fā)癥及相關危險因素：一項前瞻性觀察研究

罌粟花anesthGH 2023-07-13 發(fā)布于貴州

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普通外科手術中經(jīng)橈動脈穿刺置管監(jiān)測血流動力學的并發(fā)癥及相關危險因素：一項前瞻性觀察研究

貴州醫(yī)科大學麻醉與心臟電生理課題組

翻譯：張中偉編輯：柏雪審校：曹瑩

目的:觀察術中橈動脈穿刺置管的短期并發(fā)癥及其相關危險因素。

方法：本研究納入年齡18歲以上的成年住院患者，他們在2020年4月8日至11月30日期間接受了普通外科手術并經(jīng)橈動脈穿刺置管。我們使用20G動脈穿刺針進行穿刺，手動按壓止血。從電子醫(yī)療記錄中提取人口統(tǒng)計學、臨床、外科、麻醉和實驗室檢查數(shù)據(jù)。記錄并分析橈動脈穿刺置管的血管、神經(jīng)和感染并發(fā)癥。Logistic回歸分析用于確定與橈動脈穿刺置管相關的危險因素，并用于術中監(jiān)測。

結果：在納入的509名患者中，174人出現(xiàn)了橈動脈穿刺置管相關并發(fā)癥。穿刺部位出血/血腫和正中神經(jīng)損傷的患者分別有158例（31.0%）和16例（3.1%），沒有患者出現(xiàn)套管相關感染。Logistic回歸分析顯示，女性（比值比4.49，95%CI 2.73-7.36；P<0.001）和術中接受紅細胞懸液輸注≥4U的患者（比值比5.26，95%CI 1.41-19.57；P=0.01）穿刺部位出血/血腫的幾率增加。未發(fā)現(xiàn)神經(jīng)損傷的危險因素。

結論：出血/血腫是普通外科手術中橈動脈穿刺置管術中血流動力學監(jiān)測的常見并發(fā)癥。正中神經(jīng)損傷可能是一種未被充分認識的并發(fā)癥。女性和術中大量紅細胞輸注的患者出血/血腫的風險增加；然而，神經(jīng)損傷的危險因素尚不清楚。

原始文獻來源：Qin Hou, Bin Zhou, Juanjuan He,et al.Complications and related risk factors of transradial access cannulation for hemodynamic monitoring in general surgery: a prospective observational study.[J]. BMC Anesthesiology (2023) 23:228

英文原文：

Complications and related risk factors of transradial access cannulation for hemodynamic monitoring in general surgery: a prospective observational study

Purpose To examine the short-term complications of arterial cannulation for intraoperative monitoring and their related risk factors.

Methods We included adult inpatients (≥ 18 years old) who underwent an initial transradial access (TRA) cannulation and were scheduled for general surgery between April 8 and November 30, 2020. We used 20G arterial puncture needles for puncturing and manual compression for hemostasis. Demographic, clinical, surgical, anesthetic, and laboratory data were extracted from electronic medical records. Vascular, neurologic, and infectious complications of TRA cannulation were recorded and analyzed. Logistic regression analyses were used to identify risk factors related to TRA cannulation for intraoperative monitoring.

Results Among 509 included patients, 174 developed TRA cannulation-related complications. Puncture site bleeding/hematoma and median nerve injury were observed in 158 (31.0%) and 16 (3.1%) patients, respectively. No patient developed cannula-related infections. Logistic regression analysis revealed increased odds of puncture site bleeding/hematoma in women (odds ratio 4.49, 95% CI 2.73–7.36; P < 0.001) and patients who received intraoperative red blood cell (RBC) suspension transfusion ≥ 4U (odds ratio 5.26, 95% CI 1.41–19.57; P = 0.01). No risk factors for nerve injury were identified.

Conclusion Bleeding/hematoma were a common complication of TRA cannulation for intraoperative hemodynamic monitoring during general surgery. Median nerve injury may be an under recognized complication. Female sex and extensive intraoperative RBC transfusion are associated with an increased risk of bleeding/hematoma; however, the risk factors for nerve injury remain unclear.

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