發(fā)布時(shí)間：2018-04-19 20:35

  本文選題：脊柱側(cè)彎矯形術(shù) + 動(dòng)脈壓��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]探討在脊柱側(cè)彎矯形術(shù)中,使用小兒中心靜脈導(dǎo)管進(jìn)行股動(dòng)脈穿刺置管測量有創(chuàng)動(dòng)脈血壓的安全性和有效性。[方法]選擇從2015年8月至2016年10月期間在昆明醫(yī)科大學(xué)第二附屬醫(yī)院擬行脊柱側(cè)彎矯形術(shù)的患者24例,美國麻醉醫(yī)師協(xié)會(huì)(American Society of Anesthesiologists,ASA)分級Ⅰ～Ⅱ級�；颊呔捎渺o脈快誘導(dǎo)方法,并在氣管插管靜吸復(fù)合全身麻醉下實(shí)施手術(shù)。誘導(dǎo)插管完成后,將患者隨機(jī)分為A組和B組,每組各12人。A組病人使用動(dòng)脈穿刺針行橈動(dòng)脈穿刺置管,并用單腔中心靜脈導(dǎo)管行股動(dòng)脈穿刺置管,分別連接進(jìn)口動(dòng)脈壓力轉(zhuǎn)換器與監(jiān)護(hù)儀并測量橈動(dòng)脈和股動(dòng)脈的動(dòng)脈血壓;B組病人單純用動(dòng)脈穿刺針進(jìn)行橈動(dòng)脈置管測橈動(dòng)脈動(dòng)脈血壓。依次選取手術(shù)開始前(T1)、矯形開始時(shí)(T2)、出血量較大時(shí)(T3)、術(shù)中清醒試驗(yàn)時(shí)(T4)、術(shù)畢清醒試驗(yàn)時(shí)(T5)、進(jìn)入重癥監(jiān)護(hù)病房(IntensiveCareUnit,ICU)時(shí)(T6)、進(jìn)入 ICU 后 6 小時(shí)(T7)、進(jìn)入 ICU 后12小時(shí)(T8)8個(gè)時(shí)間點(diǎn),分別記錄橈動(dòng)脈和/或股動(dòng)脈收縮壓(Systolic Arterial Pressure,SAP)、舒張壓(Diastolic Arterial Pressure,DAP)和平均動(dòng)脈壓(Mean Arterial Pressure,MAP)、心率(Heart Rate,HR)等。此外,觀察并記錄橈動(dòng)脈及股動(dòng)脈置管是否出現(xiàn)以下相關(guān)并發(fā)癥及例數(shù):(1)術(shù)前穿刺置管困難、動(dòng)脈痙攣;(2)麻醉過程中及在ICU監(jiān)護(hù)過程中發(fā)生導(dǎo)管打折或脫出、穿刺置管處遠(yuǎn)端肢體血液循環(huán)障礙(尤其是A組股動(dòng)脈穿刺側(cè)下肢是否出現(xiàn)下肢青紫、浮腫等);(3)拔除導(dǎo)管后穿刺部位出現(xiàn)血腫及滲血;(4)一周后隨訪穿刺部位發(fā)生術(shù)后感染及例數(shù)。將收集來的A組橈動(dòng)脈和股動(dòng)脈的收縮壓、舒張壓、平均動(dòng)脈壓壓力值進(jìn)行組內(nèi)比較,并對A組和B組的橈動(dòng)脈和股動(dòng)脈收縮壓、舒張壓、平均動(dòng)脈壓的壓力值以及A、B兩組的心率進(jìn)行組間比較。統(tǒng)計(jì)并比較兩組橈動(dòng)脈和股動(dòng)脈置管發(fā)生術(shù)前置管困難、動(dòng)脈痙攣,術(shù)中及術(shù)后在ICU發(fā)生導(dǎo)管打折及脫出、穿刺側(cè)下肢循環(huán)障礙,拔除導(dǎo)管后出現(xiàn)滲血、血腫和穿刺部位感染等并發(fā)癥的例數(shù)和發(fā)生率。[結(jié)果]兩組病人的一般情況:年齡、身高、體重和手術(shù)時(shí)間經(jīng)比較差異無統(tǒng)計(jì)學(xué)意義(P0.05);A組各個(gè)時(shí)期橈動(dòng)脈和股動(dòng)脈SAP、DAP和MAP的壓力值自身比較差異無統(tǒng)計(jì)學(xué)意義(P0.05);A組股動(dòng)脈和B組橈動(dòng)脈各個(gè)時(shí)期SAP、DAP和MAP的壓力差值差異無統(tǒng)計(jì)學(xué)意義(P0.05);A、B兩組心率各個(gè)時(shí)期比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。A、B兩組共24例患者均進(jìn)行了橈動(dòng)脈穿刺置管測壓:(1)發(fā)生術(shù)前橈動(dòng)脈穿刺置管困難4例(16.7%),其中A、B組各2例;發(fā)生動(dòng)脈痙攣1例(A組)(4.2%)。(2)發(fā)生橈動(dòng)脈導(dǎo)管打折5例(20.8%),其中A組3例(術(shù)中2例,進(jìn)入ICU后1例),B組2例(均發(fā)生在術(shù)中);發(fā)生橈動(dòng)脈導(dǎo)管脫出2例(2.3%),其中A、B組各1例(均發(fā)生在術(shù)中)。(3)拔除橈動(dòng)脈置管后,發(fā)現(xiàn)局部小血腫3例(12.5%),其中A組1例,B組2例;出現(xiàn)滲血2例(8.3%),其中A、B組各1例。A組行中心靜脈導(dǎo)管股動(dòng)脈穿刺測血壓的12名患者術(shù)前、術(shù)中和進(jìn)入ICU監(jiān)護(hù)過程中均未出現(xiàn)明顯并發(fā)癥,拔除中心靜脈導(dǎo)管后,出現(xiàn)1例局部小血腫(8.3%),發(fā)現(xiàn)1例穿刺部位的滲血(8.3%)。橈動(dòng)脈置管和股動(dòng)脈置管測血壓的患者均未發(fā)現(xiàn)術(shù)中及進(jìn)入ICU監(jiān)護(hù)中穿刺處遠(yuǎn)端肢體血液循環(huán)障礙;在拔管后均未發(fā)現(xiàn)需要外科處理的大血腫,一周隨訪均未發(fā)現(xiàn)與動(dòng)脈置管相關(guān)的感染。[結(jié)論](1)脊柱側(cè)彎矯形術(shù)中使用中心靜脈導(dǎo)管行股動(dòng)脈置管測壓與橈動(dòng)脈置管測壓在各個(gè)時(shí)段測量得出的動(dòng)脈血壓是一致的。(2)脊柱側(cè)彎矯形術(shù)中使用中心靜脈導(dǎo)管行股動(dòng)脈置管測壓與橈動(dòng)脈置管測壓相比,發(fā)生導(dǎo)管打折脫出及局部血腫的可能性更低,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.

【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614

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