实时二维超声引导下颈内静脉穿刺置管术安全性与有效性的系统评价

Safety and Effectiveness of Real-time Two-dimensional Ultrasound Guidance for Internal Jugular Vein Cannulation: A Systematic Review

目的系统评价解剖标志定位法(ALM)与实时二维超声引导(RTUS)下行颈内静脉穿刺置管术的有效性及安全性。方法计算机检索Pub Med、EMbase、Web of Knowledge、CBM、Wan Fang Data和CNKI数据库,查找关于ALM与RTUS下行颈内静脉穿刺置管术比较的随机对照试验(RCT),检索时限均为从建库至2014年5月1日。由2位评价员按纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用Rev Man 5.3软件进行Meta分析。结果共纳入10个RCT,共1 973例患者。Meta分析结果显示:与ALM法相比,RTUS法穿刺失败率明显降低[OR=0.08,95%CI(0.05,0.15),P<0.000 01]。在安全性方面,与ALM法相比,RTUS法动脉损伤率明显降低[peto-OR=0.22,95%CI(0.14,0.37),P<0.000 01]和气胸发生率明显降低[peto-OR=0.13,95%CI(0.04,0.40),P=0.000 3]。结论 RTUS法较ALM法用于颈内静脉穿刺置管术具有创伤小、成功率高、并发症少等特点。鉴于纳入研究数量和质量有限,上述结论尚需开展更多研究予以验证。

Objective To systematically review the effectiveness and safety of anatomic landmarks positioning method （ALM） and real-time two-dimensional ultrasound （RTUS） guidance in the internal jugular vein cannulation. Methods We searched PubMed, EMbase, Web of Knowledge, CBM, WanFang Data and CNKI for randomized controlled trials （RCTs） concerning the effectiveness and safety of ALM and RTUS in the internal jugular vein catheterization up to May 1st, 2014. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assess methodological quality of included studies. Then meta-analysis was performed using RevMan 5.3 software. Results A total of 10 RCTs involving 1 973 cases were included in the meta- analysis. The results of meta-analysis showed that, compared with the ALM method, the RTUS method reduced puncture failure rate （OR=0.08, 95%CI 0.05 to 0.15, P〈0.000 01）. For safety, compared with the ALM method, the RTUS method was significantly lower in arterial injury rate （peto-OR=0.22, 95%CI 0.14 to 0.37, P〈0.000 01）, and the incidence of pneumothorax （peto-OR=0.13, 95%CI 0.04 to 0.40, P=0.000 3）. Condusion Compared to the ALM method, the RTUS method has characteristics such as causing fewer traumas, and having higher success rate and fewer complications. Due to limited quantity and quality of the included studies, the above conclusion still needs to be verified by conducting more studies.