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本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见 Brachial Arterial Pressure Monitoring during Cardiac Surgery Rarely Causes Complications 背景与目的 大动脉压力的监测中肱动脉插管术优于桡动脉插管术，而由于肱动脉插管术可能引发无侧支循环的大血管插管后的相关并发症，所以很少应用于临床。目前肱动脉插管术引发的相关并发症具体情况并不清楚，因此本文将通过一个大样本量的心脏手术患者队列试验评估肱动脉插管术相关并发症的发生率。 方 法 通过调取2007-2015年期间美国胸外科医师学会的成人心脏外科手术数据和克利兰医学中心围手术期健康文件系统注册表确认心脏手术中行肱动脉插管术患者的详细临床转归。再根据国际疾病分类，第九版诊断和程序代码，现行术语程序代码和心胸外科协会的常用语将心脏手术患者术后6个月内的并发症进行分类。随后通过查阅患者的电子病历确认推测的并发症与肱动脉插管术的关联性。其中并发症分为三大类：（1）血管类（2）周围神经损伤类（3）感染类。最后本文评估了肱动脉插管术并发症与患者自身合并症以及相应并发症与住院时长和住院期间死亡率之间的关联。 结 果 一共纳入21,597例患者，其中777例患者发生了血管或者神经损伤或局部感染，但仅44例（发生率0.19%，[95%CI, 0.14%-0.26%]）可能与肱动脉插管术有关。44例中血管并发症33例（发生率0.15%，[95%CI, 0.10%-0.23%]），确定或可能的相关感染并发症8例（发生率0.04%，[95%CI, 0.02%-0.08%]），相关的神经并发症0例。罹患外周动脉疾病的患者可增加肱动脉插管术并发症的发生风险，而肱动脉插管术的并发症可延长患者住院时间并增加住院期间死亡率。 结 论 心脏手术中采用肱动脉插管术监测血流动力学改变引起相关的并发症很少。 原始文献摘要 Asha Singh, M.D., Bobby Bahadorani, D.O., Brett J. Wakefield, M.D., Natalya Makarova, M.S.,Priya A. Kumar, M.D., Michael Zhen-Yu Tong, M.D., M.B.A., Daniel I. Sessler, M.D.,Andra E. Duncan, M.D., M.S. BACKGROUND: Brachial arterial catheters better estimate aortic pressure than radial arterial catheters but are used infrequentlybecause complications in a major artery without collateral flow are potentially serious. However, the extent to which brachial artery cannulation promotes complications remains unknown. The authors thus evaluated a large cohort of cardiac surgical patients to estimate the incidence of related serious complications. .METHODS: The institutional Society of Thoracic Surgeons Adult Cardiac Surgery Database and Perioperative Health Documentation System Registry of the Cleveland Clinic were used to identify patients who had brachial artery cannulation between 2007 and 2015. Complications within 6 months after surgery were identified by International Classification of Diseases, Ninth Revision diagnostic and procedural codes, Current Procedural Terminology procedure codes, and Society of Thoracic Surgeons variables. The authors reviewed electronic medical records to confirm that putative complications were related plausibly to brachial arterial catheterization. Complications were categorized as (1) vascular, (2) peripheral nerve injury, or (3) infection. The authors evaluated associations between brachial arterial complications and patient comorbidities and betweencomplications and in-hospital mortality and duration of hospitalization RESULTS: Among 21,597 qualifying patients, 777 had vascular or nerve injuries or local infections, but only 41 (incidence 0.19% [95% CI, 0.14 to 0.26%]) were potentially consequent to brachial arterial cannulation. Vascular complications occurred in 33 patients (0.15% [0.10 to 0.23%]). Definitely or possibly related infection occurred in 8 (0.04% [0.02 to 0.08%]) patients. There were no plausibly related neurologic complications. Peripheral arterial disease was associated with increased risk of complications. Brachial catheter complications were associated with prolonged hospitalization and in-hospital mortality. CONCLUSIONS: Brachial artery cannulation for hemodynamic monitoring during cardiac surgery rarely causes complications. 麻醉学文献进展分享 联系我们 |
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