超声引导下中心静脉穿刺中短轴法与长轴法的应用比较:更新的系统评价与meta分析

Short-axis versus long-axis approach in ultrasound-guided central venous cannulation: an updated systematic review and meta-analysis

目的旨在比较超声下短轴法与长轴法在中心静脉穿刺的成功率与安全性。方法两位评价人员独立检索了PubMed数据库, Cochrane Library, Science Direct及Web of Science等数据库,检索时限为2011年1月~2017年10月。观察指标穿刺首次成功率,总成功率及并发症发生率。通过建立固定效应模型或随机效模型来计算95%置信区间(CI)的加权平均差异和相对风险(RR)。结果对7篇纳入的随机进行Meta分析显示:静脉穿刺短轴法的首次成功率高于长轴法(RR=1.27,95%CI:1.11~1.46;P=0.0005,I^2=49%),但总穿刺成功率未见差异(RR=1.04,95%CI:0.97~1.10;P=0.27,I^2=84%)。采用短轴法导致误穿动脉的并发症发生率低于长轴法(RR=1.04,95%CI:1.01~1.08;P=0.01,I^2=30%)。结论相较于长轴法,超声引导下短轴法应用于中心静脉穿刺可以增加穿刺的首次成功率,减少误穿动脉的发生率。

Objective To compare the success rate and safety of the short-axis(SAX) approach and long-axis(LAX) approach to ultrasound-guided central venous cannulation. Methods Electronic bibliographic databases including PubMed, Cochrane Library,Science Direct, and Web of Science were searched for randomized controlled trials comparing ultrasound-guided central venous cannulation via the LAX and SAX approaches published during the period from January, 2011 to October, 2017. We extracted the data from the eligible studies and assessed the first-attempt success rate, overall puncture success rate and complication rate of the two approaches. The relative risk(RR) with the 95% CI was calculated using a fixed or random effects model. Results Seven randomized controlled trials were included for meta-analysis. The results showed that the first-attempt success rate was significantly higher in the SAX group than in the LAX group(RR=1.27, 95%CI: 1.11-1.46;P=0.0005, I^2=49%), but the overall puncture success rate did not differ significantly between the two approaches(RR=1.04, 95% CI: 0.97-1.10;P=0.27, I^2=84%). The incidence of accidental arterial puncture with the SAX approach was significantly lower than that with the LAX approach(RR=1.04;95%CI: 1.01-1.08;P=0.01, I^2=30%). Conclusion Ultrasound-guided central venous cannulation via the SAX approach, as compared with the LAX approach, can increase first-attempt success rate and reduce the incidence of accidental arterial puncture.