婴幼儿超声引导下行颈内静脉穿刺置管术有效性与安全性的Meta分析

Effectiveness and Safety of the Ultrasound Guidance for Internal Jugular Vein Catheterization in Pediatric Patients:A Meta-analysis

目的系统评价婴幼儿患者中应用解剖标志定位法(ALM)与超声(US)引导下颈内静脉穿刺置管的有效性与安全性。方法计算机检索Pub Med、EMbase、The Cochrane Library(2016年10期)、CBM、Wan Fang Data和CNKI数据库,并检索Google Scholar、馆藏期刊等其他资源,搜集有关婴幼儿ALM和US引导颈内静脉穿刺置管术的随机对照试验(RCT),检索时限均为从建库至2016年10月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果共纳入13个RCT,合计1 026例患者。Meta分析结果显示:US组的穿刺成功率明显高于ALM组[RR=1.21,95%CI(1.09,1.34),P=0.000 5],动脉损伤率明显低于ALM组[RR=0.19,95%CI(0.07,0.50),P=0.000 7],但两组的血肿形成率差异无统计学意义[RR=0.35,95%CI(0.09,1.31),P=0.12]。结论当前证据显示,对婴幼儿患者行超声引导下的颈内静脉穿刺置管的整体安全性与有效性优于解剖标志定位法,但受纳入研究数量和质量所限,本研究结论尚需更多高质量研究进行验证。

Objective To systematically evaluate the efficacy and safety of anatomical landmark method （ALM） versus ultrasound （US）-guided internal jugular vein （IJV） catheterization in pediatric patients. Methods Databases including PubMed, EMbase, The Cochrane Library （Issue 10, 2016）, CNKI, CBM, WanFang Data and CNKI were searched from inception to October 2016 to collect randomized controlled trials （RCTs） of landmark-guided versus ultrasound-guided IJV catheterization in pediatric patients who underwent elective surgery. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then RevMan 5.3 software was used to perform meta-analysis. Results A total of 13 RCTs involving 1 026 pediatric patients were included. The results of meta- analysis showed that, the overall success rate （RR=1.21, 95%CI 1.09 to 1.34, P=0.000 5） and arterial puncture rate （RR=0.19, 95%CI 0.07 to 0.50, P=O.O00 7） of US-guided IJV catheterization were both significantly superior to the ALM group. Whereas there was no significant difference between two groups as for the incidence of hematoma formation （RR=0.35, 95%CI 0.09 to 1.31,P=0.12）. Conclusion Current evidence shows that, for IJV catheterization of pediatric patients, both the effectiveness and safety of ultrasound-guided technique are better than the landmark-guided. Since the quantity and quality of included studies are limited, the conclusion of this study needs more high quality studies to verify.