PICC超声引导下肘上置管的穿刺置管效果及并发症的系统评价

Influence of PICC Ultrasound Guidance on Elbow Puncture and Catheterization and Its Complications: A Systematic Review

目的系统评价PICC超声引导下肘上置管对穿刺置管成功率、并发症发生率的影响。方法计算机检索The Cochrane Library(2012年第3期)、JBI循证护理中心图书馆、MEDLINE、EMbase、CBM、VIP、CNKI和WanFang Data,收集所有关于PICC超声引导下肘上置管和常规肘下置管对穿刺置管成功率、并发症发生率影响的随机对照试验、临床对照试验和队列研究。检索时限均为从建库至2012年3月。由2名研究员按照纳入和排除标准筛选文献、提取资料、评价质量,然后采用RevMan 5.1软件进行Meta分析或仅行描述性分析。结果共纳入11个随机对照试验、5个临床对照试验、4个队列研究,4 052例患者。Meta分析结果显示:超声引导下结合改良赛丁格技术肘上置管的一次穿刺成功率、置管成功率均较常规肘下置管高,其差异均有统计学意义[OR=4.71,95%CI(1.97,11.28),P=0.000 5;OR=8.63,95%CI(1.92,38.82),P=0.005]。常规肘下置管的静脉炎发生率较超声引导下肘上置管高,其差异有统计学意义[OR=0.13,95%CI(0.08,0.21),P<0.000 01]。结论 PICC超声引导下结合改良赛丁格技术肘上置管较常规肘下置管在提高穿刺置管成功率和降低并发症发生率方面具有明显优势。

Objective To systematically evaluate the influence of PICC（peripherally inserted central catheter） ultrasound guidance on success rates and incidences of complications of elbow catheterization.Methods The Cochrane Library（Issue 3,2012）,Library of JBI evidence-based nursing center,MEDLINE,EMbase,CBM,VIP,CNKI and WanFang Data were searched for relevant studies to influence on success rates of puncture and catheterization and complications from upper arm placement of PICC ultrasound guidance as well as conventional PICC placement from inception to March,2012.The data were extracted according to the inclusion and exclusion criteria by two reviewers,the quality of included studies was also evaluated.Meta-analysis was conducted using RevMan 5.1,or only descriptive analysis was conducted instead.Results Eleven randomized controlled trials,five clinical controlled trials and four cohort studies were included,involving 4 052 patients.The results of meta-analysis showed that,upper arm placement of PICC ultrasound guidance combined with modified Seldinger technique was associated with significantly higher one-time success rates of puncture and catheterization than conventional PICC placement below the elbow,with significant differences（OR=4.71,95%CI 1.97 to 11.28,P=0.000 5;OR=8.63,95%CI 1.92 to 38.82,P=0.005）.Conventional elbow catheterization had a significantly higher incidence of phlebitis than catheterization on the elbow that under the guidance of PICC ultrasound and modified Seldinger technique（OR=0.13,95%CI 0.08 to 0.21,P0.000 01）.Conclusion Elbow catheterization under the guidance of PICC ultrasound combined with modified Seldinger technique has an obvious advantage in improving the success rates of puncture and catheterization and reducing the incidence of complications,compared with conventional elbow catheterization.