Ultrasonic locating devices for central venous cannulation: meta-analysis
Ultrasonic locating devices for central venous cannulation: meta-analysis
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DOI：
10.1136/bmj.327.7411.361
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发表时间：
2003-08-16
影响因子：
105.7
通讯作者：
Thomas, S
中科院分区：
文献类型：
--
作者：
Hind, D;Calvert, N;Thomas, S
目的评价超声引导中心静脉插管的临床有效性。数据来源15个电子书目数据库，涵盖生物医学，科学，社会科学，卫生经济学，系统评价和Meta分析随机对照试验的分析。人群安排中心静脉通路的患者。干预回顾使用真实的时间二维超声或多普勒针的指导，数据提取导管放置失败的风险（主要结果）、放置并发症的风险、首次尝试放置失败的风险、成功插入导管的尝试次数和成功插入导管的时间（秒）数据综合确定了18个试验（1646名参与者）。与界标方法相比，成人颈内静脉插管的真实的时间二维超声引导总体（相对风险0.14，95%置信区间0.06 - 0.33）和首次尝试（0.59，0.39 - 0.88）的失败率均显著较低。有限的证据支持成人锁骨下静脉和股静脉手术的二维超声引导（分别为0.14、0.04 - 0.57和0.29、0.07 - 1.21）。3项针对婴儿的研究证实，二维超声在颈内静脉手术中的成功率较高（0.15，0.03 - 0.64）。多普勒引导的成人颈内静脉插管比界标方法更成功（0.39，0.17至0.92），但界标方法在锁骨下静脉手术中更成功（1.48，1.03至2.14）。这些技术在婴儿颈内静脉插管中没有发现显著差异。间接比较的相对风险表明，二维超声将是更成功的，比多普勒引导锁骨下静脉手术在成人（0.09，0.02至0.38。结论证据支持使用二维超声中心静脉插管。
Objectives To assess the evidence for the clinical effectiveness of ultrasound guided central venous cannulation.Data sources 15 electronic bibliographic databases, covering biomedical, science, social science, health economics, and grey literature.Design Systematic review and meta-analysis of randomised controlled trials.Populations Patients scheduled for central venous access.Intervention reviewed Guidance using real time two dimensional ultrasonography or Doppler needles and probes compared with the anatomical landmark method of cannulation.Data extraction Risk of failed catheter placement (primary outcome), risk of complications from placement, risk of failure on first attempt at placement, number of attempts to successful catheterisation, and time (seconds) to successful catheterisation.Data synthesis 18 trials (1646 participants) were identified. Compared with the landmark method, real time two dimensional ultrasound guidance for cannulating the internal jugular vein in adults was associated with a significantly lower failure rate both overall (relative risk 0.14, 95% confidence interval 0.06 to 0.33) and on the first attempt (0.59, 0.39 to 0.88). Limited evidence favoured two dimensional ultrasound guidance for subclavian vein and femoral vein procedures in adults (0.14, 0.04 to 0.57 and 0.29, 0.07 to 1.21, respectively). Three studies in infants confirmed a higher success rate with two dimensional ultrasonography for internal jugular procedures (0.15, 0.03 to 0.64). Doppler guided cannulation of the internal jugular vein in adults was more successful than the landmark method (0.39, 0.17 to 0.92), but the landmark method was more successful for subclavian vein procedures (1.48, 1.03 to 2.14). No significant difference was found between these techniques for cannulation of the internal jugular vein in infants. An indirect comparison of relative risks suggested that two dimensional ultrasonography would be more successful than Doppler guidance for subclavian vein procedures in adults (0.09, 0.02 to 0.38).Conclusions Evidence supports the use of two dimensional ultrasonography for central venous cannulation.