远端与传统桡动脉导管置入术在重症监护环境中进行血流动力学监测：一项随机、对照、非劣效性试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：赵游霄 编辑：赵游霄 审校：曹莹
背景：
动脉置管术是危重症患者血流动力学监测的基础，但动脉压波形不稳定和丢失仍是临床上的重大问题。远端桡动脉（dRA）途径已被提议作为传统桡动脉（RA）途径的潜在替代方案。这是首个随机临床试验，通过评估首次成功率和危重症 ICU 患者动脉压波形的稳定性，来比较 dRA 与 RA 置管术的相对有效性和可靠性。
方法：
这项随机对照试验纳入了 200 名需要动脉置管的危重症患者，将其随机分为 dRA 组（n = 100）和传统 RA 组（n = 100）。所有操作均使用标准的 20 号聚氨酯外周静脉导管。主要结局指标包括首次置管成功率和置管后最初 72 小时内动脉压波形丢失的频率。次要结局指标包括置管时间、置管及管理期间的并发症、止血时间和导管留置时间。采用 Bonferroni 校正进行多重检验（α = 0.025）。
结果：
首次成功率在 dRA 组和 RA 组之间相当（86% 对 84%，P = 0.688）。dRA 组在三天内动脉压波形丢失的情况显著更少（第 1 天：1.0 [0.0, 2.0] 对 2.0 [1.0, 2.0]；第 2 天：1.0 [0.0, 1.0] 对 2.0 [1.0, 2.0]；第 3 天：0.0 [0.0, 1.0] 对 1.0 [1.0, 2.0]；所有 P < 0.001）。两组均实现了 100% 的操作成功率，且无穿刺部位转换。dRA 组的动脉导管置入时间更长（P < 0.001）。置管期间、置管管理和拔管后的并发症发生率在两组之间相似。dRA 组的止血时间显著更短（2.6 ± 1.5 分钟对 4.2 ± 0.9 分钟，P < 0.001）。两组的导管留置时间相似（76.6 ± 16.7 小时对 77.4 ± 16.4 小时，P = 0.724）。
结论：
原始文献：
Anesthesiology B, Peng C, Wu W, et al. 7.19 [J]. ., [no date].
Distal versus conventional radial artery catheterization for hemodynamic monitoring in intensive care setting: a randomized, controlled, non-inferiority trial
INTRODUCTION:
Arterial catheterization is fundamental for hemodynamic monitoring in critically ill patients, yet instability and loss of arterial pressure waveform remain clinically significant issues. The distal radial artery (dRA) approach has been proposed as a potential alternative to the conventional radial artery (RA) approach. This is the first randomized clinical trial to assess the comparative efficacy and reliability of dRA versus RA catheterization by examining first-attempt success rates and the stability of arterial pressure waveforms in critically ill ICU patients.
METHODS:
This randomized controlled trial enrolled 200 critically ill patients requiring arterial catheterization, assigning them to either dRA (n = 100) or conventional RA (n = 100) groups. All procedures utilized a standard 20-gauge polyurethane peripheral intravenous catheter. Co-primary outcomes included first-attempt success rate and frequency of arterial pressure waveform loss during the initial 72-h period. Secondary outcomes included catheterization time, complications during insertion and management, hemostasis time, and catheter duration. Bonferroni correction was applied for multiple testing (α = 0.025).
RESULTS:
First-attempt success rates were comparable between dRA and RA groups (86% vs. 84%, P = 0.688). The dRA group experienced significantly fewer arterial pressure waveform losses across all three days (Day 1: 1.0 [0.0, 2.0] vs. 2.0 [1.0, 2.0]; Day 2: 1.0 [0.0, 1.0] vs. 2.0 [1.0, 2.0]; Day 3: 0.0 [0.0, 1.0] vs. 1.0 [1.0, 2.0]; all P < 0.001). Both groups achieved 100% procedural success with no site crossovers. Arterial catheterization time was longer in the dRA group (P < 0.001). Complication rates during catheterization, management, and after removal were similar between groups. Hemostasis time was significantly shorter in the dRA group (2.6 ± 1.5 min vs. 4.2± 0.9 min, P < 0.001). Catheter duration was similar between groups (76.6 ± 16.7 vs. 77.4 ± 16.4 h, P = 0.724).
DISCUSSION:
While first-attempt success rates were similar, the dRA approach offered greater arterial pressure waveform stability and shorter hemostasis time than the conventional RA approach, without increasing complications. Thus, dRA may be a preferable option for arterial catheterization in critically ill patients.
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