普通外科手术中经桡动脉穿刺置管监测血流动力学的并发症及相关危险因素：一项前瞻性观察研究
贵州医科大学 麻醉与心脏电生理课题组
翻译：张中伟 编辑：柏雪 审校：曹莹
目的:观察术中桡动脉穿刺置管的短期并发症及其相关危险因素。
方法：本研究纳入年龄18岁以上的成年住院患者，他们在2020年4月8日至11月30日期间接受了普通外科手术并经桡动脉穿刺置管。我们使用20G动脉穿刺针进行穿刺，手动按压止血。从电子医疗记录中提取人口统计学、临床、外科、麻醉和实验室检查数据。记录并分析桡动脉穿刺置管的血管、神经和感染并发症。Logistic回归分析用于确定与桡动脉穿刺置管相关的危险因素，并用于术中监测。
结果：在纳入的509名患者中，174人出现了桡动脉穿刺置管相关并发症。穿刺部位出血/血肿和正中神经损伤的患者分别有158例（31.0%）和16例（3.1%），没有患者出现套管相关感染。Logistic回归分析显示，女性（比值比4.49，95%CI 2.73-7.36；P<0.001）和术中接受红细胞悬液输注≥4U的患者（比值比5.26，95%CI 1.41-19.57；P=0.01）穿刺部位出血/血肿的几率增加。未发现神经损伤的危险因素。
结论：出血/血肿是普通外科手术中桡动脉穿刺置管术中血流动力学监测的常见并发症。正中神经损伤可能是一种未被充分认识的并发症。女性和术中大量红细胞输注的患者出血/血肿的风险增加；然而，神经损伤的危险因素尚不清楚。
原始文献来源：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
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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