皮下注射硝酸甘油在小儿桡动脉插管中的应用：随机对照试验

本文由“罂粟花”授权转载

皮下注射硝酸甘油在小儿桡动脉插管中的应用：随机对照试验

翻译：唐剑  编辑：冯玉蓉  审校：曹莹

背景：由于小儿桡动脉血管较细使得桡动脉插管更具有挑战性。硝酸甘油是一种有效的血管扩张剂，通过增加桡动脉内径和防止成年患者的血管痉挛来提高桡动脉插管的成功率。因此我们假设皮下注射硝酸甘油可提高小儿桡动脉插管的成功率。

方法：本项双盲、随机、对照、单中心研究纳入了全麻期间需要桡动脉插管的儿童患者113例(n = 113，年龄小于2岁)。参与者被随机分为硝酸甘油组(n=57)和对照组(n=56)。全身麻醉诱导后，在超声引导下于桡动脉上方皮下注射硝酸甘油(5μg/kg 共0.5ml)或生理盐水(0.5 ml)，注射时间超过10 s。3分钟后于超声引导下行桡动脉置管。分别于皮下注射前后和插管后测量桡动脉内径。主要评价指标是首次插管成功率。次要评价指标包括桡动脉直径以及血肿和血管痉挛在内的总体并发症发生率。

结果：共有113名患儿被纳入分析。桡动脉首次置管成功率，硝酸甘油组显著高于对照组（91.2% [52 of 57] vs. 66.1% [37 of 56]；P = 0.002; OR 5.3；95% CI 1.83 ~15.6；ARR -25.2%；95% CI -39.6 ~ -10.7%）。皮下注射硝酸甘油增加的桡动脉直径大于注射生理盐水(25.0 ± 19.5% vs. 1.9 ± 13.1%；95% CI 平均差 16.9 ~ 29.3%；P < 0.001)。硝酸甘油组的总并发症发生率明显低于对照组（3.5% [2 of 57] vs. 31.2% [18 of 56]；P = 0.001；odds ratio, 0.077；95% CI 0.017~0.350；ARR 28.6%；95% CI 15.5 ~ 41.8%）。

结论：小儿桡动脉插管前皮下注射硝酸甘油可提高一次性置管成功率，降低总体并发症发生率。

原始文献来源： Jang YE, Ji SH, Kim EH, et,al. Subcutaneous Nitroglycerin for Radial Arterial Catheterization in Pediatric Patients: A Randomized Controlled Trial. [J].Anaesthesia 2020;133:53-63.

Subcutaneous Nitroglycerin for Radial Arterial Catheterization in Pediatric Patients: A Randomized Controlled Trial

Abstract

BACKGROUND: Pediatric radial artery cannulation is challenging because of the small vessel size. Nitroglycerin is a potent vasodilator and facilitates radial artery cannulation by increasing the internal diameter and preventing the vasospasm in adult patients. The authors hypothesize that subcutaneous nitroglycerin injection will improve the success rate of pediatric radial artery cannulation.

METHODS: This double-blind, randomized, controlled, single-center study enrolled pediatric patients (n = 113, age less than 2 yr) requiring radial artery cannulation during general anesthesia. The participants were randomized into the nitroglycerin group (n = 57) or control group (n = 56). After inducing general anesthesia, nitroglycerin solution (5 μg/kg in 0.5 ml), or normal saline (0.5 ml) was subcutaneously injected above the chosen radial artery over 10 s with ultrasound guidance. Three minutes later, the ultrasound-guided radial artery cannulation was performed. Radial artery diameter was measured before and after the subcutaneous injection and after cannulation. The primary outcome was the first-attempt successful cannulation rate. The secondary outcomes included the diameter of the radial artery and the overall complication rate including hematoma and vasospasm.

RESULTS: A total of 113 children were included in the analysis. The nitroglycerin group had a higher first-attempt success rate than the control group (91.2% [52 of 57] vs. 66.1% [37 of 56]; P = 0.002; odds ratio, 5.3; 95% CI, 1.83 to 15.6; absolute risk reduction, -25.2%; 95% CI, -39.6 to -10.7%). Subcutaneous nitroglycerin injection increased the diameter of the radial artery greater than normal saline (25.0 ± 19.5% vs. 1.9 ± 13.1%; 95% CI of mean difference, 16.9 to 29.3%; P < 0.001). Overall complication rate was lower in the nitroglycerin group than in the control group (3.5% [2 of 57] vs. 31.2% [18 of 56]; P = 0.001; odds ratio, 0.077; 95% CI, 0.017 to 0.350; absolute risk reduction, 28.6%; 95% CI, 15.5 to 41.8%).

CONCLUSIONS: Subcutaneous nitroglycerin injection before radial artery cannulation improved the first-attempt success rate and reduced the overall complication rates in pediatric patients.

免责声明：

文中所涉及药物使用、疾病诊疗等内容仅供参考。