三级防护下超声引导外周动脉置管在新型冠状病毒肺炎重症患者中的应用

目的探讨超声引导技术在重症新型冠状病毒肺炎(coronavirus disease 2019, COVID-19)患者外周动脉导管留置中的应用效果。方法回顾性收集并分析2020年2月至4月北京协和医院援鄂医疗队诊治的留置外周动脉导管的重症COVID-19患者临床资料。采用超声引导外周动脉置管的患者为研究组,采用传统触诊法置管的患者为对照组。比较两组患者动脉导管留置情况和并发症发生率。结果共60例符合纳入和排除标准的重症COVID-19患者入选本研究。其中研究组30例、对照组30例。研究组外周动脉首次置管成功率(63.3%比26.7%)、总穿刺成功率[(79.43±25.79)%比(53.07±30.21)%]均高于对照组(P均<0.05),穿刺次数[(1.43±0.56)次比(2.50±1.28)次]少于对照组(P<0.05)。研究组外周动脉导管留置的24 h失用率(6.7%比30.0%)、局部血肿发生率(10.0%比36.7%)、阻塞曲折发生率(3.3%比40.0%)均低于对照组(P均<0.05)。结论三级防护下,应用超声引导技术对重症COVID-19患者进行外周动脉置管,可提高首次置管成功率,减少穿刺次数,降低并发症发生率。

Application of Ultrasound-guided Peripheral Arterial Puncture in Severe Patients with Coronavirus Disease 2019 Under Three-level Protection

Objective To explore the application of ultrasound-guided arterial line placement in severe patients with COVID-19. Methods From February to April 2020,we retrospectively collected and analyzed the clinical data of critical patients with COVID-19 with an indwelling peripheral arterial catheter treated by the medical team of Peking Union Medical College Hospital. Patients with ultrasound-guided peripheral arterialcatheterization were taken as the study group, while patients whose arterial catheter was placed by traditional palpation were taken as the control group. The puncture condition and complication rate were compared between the two groups. Results A total of 60 severe patients with COVID-19 who met the inclusion and exclusion criteria were enrolled in this study. There were 30 cases in the study group and 30 cases in the control group. In the study group, the success rate of the first catheterization of the peripheral artery(63.3% vs. 26.7%) and the total puncture success rate [(79.43± 25.79)% vs.(53.07±30.21)%] were higher than those in the control group(all P<0.05), the puncture times(1.43±0.56 vs. 2.50±1.28) were less than those of the control group(P<0.05). The rates of 24-hour disuse(6.7% vs. 30.0%), local hematoma(10.0% vs. 36.7%), occlusion, and tortuous(3.3% vs. 40.0%) in the study group were lower than those in the control group(all P<0.05). Conclusion Under the three-level protection, ultrasound-guided arterial catheter placement for severe patients with COVID-19 can improve the success rate of catheter placement, reduce puncture times, and reduce the incidence of complications.