Prospective comparative study on the hemodynamic and functional consequences of arterial monitoring catheters in intensive care patients on the short and long term

INTRODUCTION: In intensive care wards, arterial catheters are a relevant instrument to monitor vital functions. However, the effect of arterial catheterization on hemodynamic function in elective patients in the short and long term is unknown. AIM: The objective of this study was to examine the possible damaging effects of arterial monitoring catheters on arterial functioning in intensive care patients after elective surgery. PATIENTS AND METHODS: Twenty-three patients with an arterial catheter were examined; the nonaffected arm was used as control. The use of the a. radialis/a. ulnaris ratio for the assessment of artery functioning was validated with 20 healthy individuals and the nonaffected control arm of the examined patients. Arterial function was measured with a Doppler monitoring device and a subjective assessment distress list. All patients were assessed before insertion and 1 day, 5 days, and 30 days after removal. Data were analyzed by means of multivariate analysis of variance and t test. RESULTS: A significant decrease in the a. radialis/a. ulnaris ratio was found 1 day and 5 days after removal (t1 P = .04, t5 P = .003, and multivariate analysis of variance P = .033), against no significant change after 30 days. Subjective assessment showed no relevant clinical negative impact. CONCLUSION: There is significant change in the hemodynamic function of the artery 1 day and 5 days after removal, but this significant change disappears after 30 days. An arterial monitoring catheter causes a functional arterial change in the affected arm in the short term and no significant difference in the long term. Therefore, arterial catheterization is a safe procedure after short-term cannulation. Second, the systolic blood pressure ratio of the a. radialis/a. ulnaris is a valuable tool in the assessment of the hemodynamic function of the a. radialis after radial cannulation.     

婴幼儿发育性髋关节异常的早期诊断

目的 报道采用超声波髋关节检查技术诊断新生儿和小婴儿发育性髋关节异常(DDH)和早期处理的初步经验。方法 2002年4月～2002年9月，391例临床怀疑DDH，年龄小于l岁的婴幼儿在上海儿童医学中心接受了超声波髋关节检查，其中男193例(49．4％)，女198例(50．6％)。最小年龄5d，最大年龄354d。其中新生儿24例(6．14％)，2个月婴儿52例(13．30％)，3个月婴儿54例(13．81％)，4～6个月婴儿164例(41．94％)，6～12个月婴儿97例(24．81％)。参照Graf等分类方法，检查者被分为五类，其中髋关节发育不良、髋关节半脱位和髋关节全脱位者定为DDH。髋关节发育不成熟者采取随访观察。年龄小于6个月的DDH接受了早期Pavlik吊带治疗，并采用超声波跟踪，决定治疗的终止或改动。结果 300例超声波检查正常，91例超声波检查阳性，其中42例诊断为DDH。接受随访的35例髋关节发育不成熟病例中，29例自行恢复。Pavlik吊带治疗在小于6个月DDH婴幼儿中成功率为91．67％。结论 采用超声波髋关节诊断技术可以早期发现新生儿和小婴儿DDH，并施行早期治疗，可以提高DDH在儿童期的治愈率，减少漏诊病例，简化治疗，提高疗效。