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超声诊断桡动脉穿刺后发生的血管痉挛及其影响因素分析
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摘要: 目的 探讨超声诊断桡动脉穿刺后血管痉挛的发生，并对痉挛进行形态学分类，分析影响血管痉挛类型的因素。 方法 82例行择期心脏手术患者，年龄为14~60岁，窦性心律，常规行桡动脉穿刺术。分别在桡动脉穿刺前及穿刺置管成功后即刻行二维超声检查，在穿刺10 cm范围内的最狭窄处（通常位于针尖）测量舒张末期桡动脉直径，以最狭窄处与穿刺前直径差值≥ 0.20 mm，且与穿刺前相比，狭窄程度≥ 10%判定为痉挛。最狭窄的长度≤ 10 mm判定为痉挛环，最狭窄的长度≥ 50 mm判定为痉挛段。 结果 82例患者中发生血管痉挛60例（73%），其中痉挛环29例（48%），痉挛段31例（52%）。将性别、血管直径、穿刺时间和次数、置管困难纳入多因素logistic回归模型分析，发现除了穿刺时间外（P<0.05），其他因素对血管痉挛类型没有影响。 结论 本实验用超声将动脉穿刺后血管痉挛的类型分为两种，即痉挛环，痉挛段。并且发现随着穿刺时间的延长，血管的痉挛类型越倾向于段状而非环状。
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