超声引导困难外周静脉穿刺临床应用效果的Meta分析

Clinical Application Effect of Ultrasound-guided Difficult Peripheral Intravenous Puncture:a Meta-Analysis

背景困难外周静脉穿刺可能会影响患者治疗及时性、耗费护理时间和材料、增加护理人员压力,超声引导困难外周静脉穿刺具有一定优势,但目前尚未达成一致意见。目的评价超声引导困难外周静脉穿刺的临床应用效果。方法计算机检索PubMed、EMBase数据库、Cochrane临床研究注册中心(CENTRAL),检索时间为建库至2018年4月,筛选有关超声引导/传统方法困难外周静脉穿刺效果的临床随机对照试验,其中传统组患者采用传统方法(包括盲穿)行困难外周静脉穿刺,超声组患者采用超声引导困难外周静脉穿刺。采用RevMan 5.2软件进行Meta分析。结果最终纳入10篇文献,包括593例患者。Meta分析结果显示,超声组穿刺成功率高于传统组[OR=2.39,95%CI(1.35,4.24),P=0.003];两组患者第一次穿刺成功率比较,差异无统计学意义[OR=1.60,95%CI(0.92,2.80),P=0.10];超声组患者穿刺次数少于传统组[MD=-0.73,95%CI(-1.39,-0.06),P=0.03];两组患者穿刺时间比较,差异无统计学意义[MD=-1.23,95%CI(-5.82,3.36),P=0.60]。结论现有文献证据表明,超声引导困难外周静脉穿刺可有效提高穿刺成功率,减少穿刺次数。

Backgrounds Difficult intravenous puncture may affect patients'therapeutic timeliness,cost longer nursing time and materials,and increase the pressure of nursing staff.Ultrasound-guided difficult peripheral intravenous puncture has certain advantages,but no consensus has been reached yet.Objective To evaluate the clinical application effect of ultrasound-guided peripheral intravenous puncture.Methods PubMed,EMBase,the Cochrane Central Register of Controlled Trials(CENTRAL)were searched for related clinical randomized controlled trials(RCTs)about clinical application effect of ultrasound-guided/conventional difficult peripheral intravenous puncture between establishment and April 2018,thereinto patients in convention group received traditional methods(including blind technique)for difficult peripheral intravenous puncture,while patients in ultrasound group received ultrasound-guided difficult peripheral intravenous puncture.RevMan 5.2 software was used to conduct the meta-analysis.Results Ten articles were involed,including 593 patients.Meta-analysis results showed that,success rate of puncture in ultrasound group was statistically significantly higher than that in convention group〔OR=2.39,95%CI(1.35,4.24),P=0.003〕;no statistically significant difference of success rate of the first attempt of puncture was found between the two groups〔OR=1.60,95%CI(0.92,2.80),P=0.10〕;number of attempts of puncture in ultrasound group was statistically significantly less than that in convention group〔MD=-0.73,95%CI(-1.39,-0.06),P=0.03〕;no statistically significant difference of duration of puncture was found between the two groups〔MD=-1.23,95%CI(-5.82,3.36),P=0.60〕.Conclusion According to current literature evidence,ultrasoundguided peripheral intravenous puncture can effectively improve the success rate of puncture and reduce the number of attempts of puncture.