超声引导在小儿静脉穿刺置管中应用的 Meta 分析

目的：系统评价超声引导与传统体表定位在小儿静脉穿刺置管效果差异。方法计算机检索Cochrane图书馆、PubMed、Highwire、EMbase、CBM、CNKI等中外生物医学数据库，收集有关应用超声引导与传统体表定位在小儿静脉穿刺置管效果的临床随机对照试验，检索文献日期为1993年1月-2013年1月。采用Cochrane 系统评价方法，按照纳入和排除标准限定研究对象，提取有效数据后采用RevMan 5．0软件进行Meta分析。结果共纳入应用超声引导下与传统颈内静脉穿刺效果的临床随机对照研究6项（共319例）。结果显示：超声引导组用时更短加权均数差（ WMD）＝-6．10，95％CI （-8．10～-4．10）]，穿刺成功率更高WMD＝5．06，95％CI（2．33～10．97）]，尝试次数更低时即可穿刺成功WMD＝-1．05，95％CI（-1．43～-0．68）]，并发症发生率更低WMD＝0．13，95％CI（0．55～0．34）]。结论在操作者能熟练掌握超声仪使用前提下，与传统体表定位穿刺置管相较，超声引导下可缩短用时、提高成功率、减少穿刺次数、且有效降低并发症。尤其对于传统体表定位穿刺困难的病例，超声引导下穿刺有显著优势，值得临床推广应用。

Meta analysis of the application of ultrasound-guided for the vein catheterization in infants

Objective To systematically evaluate the difference between ultrasound-guided and traditional body surface localization for the vein catheterization in infants .Methods Cochrane library , PubMed, Highwire, EMbase, China biomedical literature databases （CBM）, CNKI and so on were searched.The randomized clinical trials of ultrasound-guided and traditional body surface localization for the vein catheterization in infants were collected .The date of retrieval documents is from January 1993 to January 2013 . The evaluation method of Cochrane system was used , and the research objects were chosen according to the inclusion and exclusion criteria .The effective data were analyzed by RevMan 5.0 software through Meta analysis.Results Six randomized controlled clinical studies （319 cases） in which the ultrasound-guided and traditional body surface localization for the vein catheterizations in infants were used were chosen .The results showed that in the ultrasound-guided group the time was shorter WMD =-6.10, 95%CI （ -8.10 --4.10）],and the successful rate of puncture was higher WMD=5.06, 95%CI（2.33-10.97）], and the attempt times of puncture was less WMD=-1.05, 95%CI （ -1.43--0.68）], and the incidence rate of complication was lower WMD=0.13, 95%CI （0.55-0.34）].Conclusions On the premise of mastering the use of ultrasonic instrument , the ultrasound-guided for the vein catheterization can shorten the time , and improve the successful rate , and reduce the times of puncture , and decrease the complications compared with the traditional body surface localization .Especially for the cases of difficultly puncturing through the traditional body surface localization , the ultrasound-guided for the vein catheterization has significant advantages , and is worthy of clinical application .