超声引导桡动脉穿刺在儿科患者中应用效果的系统评价

目的探讨超声引导相对于传统触诊对儿科患者桡动脉穿刺结局的影响,为临床实践提供参考依据。方法系统检索PubMed、Cochrane library、Clinicaltrials.gov以及中国知网(CNKI)和万方数据库(Wanfang Data)从建库至2018年12月发表的与研究主题相关的所有随机对照临床试验。由2名研究人员独立地判定并提取纳入研究的数据。研究的主要结局变量为一次性穿刺成功率。运用Review Manager 5.3和TSA 0.9对收集的数据进行分析。结果共纳入8项随机对照研究,涉及710名患儿。合并后的研究结果表明,相对于传统触诊法,超声引导桡动脉穿刺能明显提升首次穿刺成功率RR=1.67,95%CI(1.35,2.06),P<0.01]和总体穿刺成功率RR=1.44,95%CI(1.22,1.71),P<0.01],降低穿刺时间SMD=-0.71,95%CI(-0.89,-0.52),P<0.01]以及血肿的发生率RR=0.10,95%CI(0.10,0.34),P<0.01]。TSA分析表明研究结论较为肯定。结论超声引导能有效提升儿科患者桡动脉穿刺成功率,减少并发症发生。

Systematic evaluation on efficiency of ultrasound-guided radial artery puncture in pediatrics

Objective To explore the effect of ultrasound guidance compared with traditional palpation on the outcome of radial artery puncture in pediatric patients,and provide evidence for clinical practice.Methods PubMed,Cochrane library,Clinicaltrials.gov and China National Knowledge Infrastructure(CNKI)and Wanfang Data were systematically searched from their inception to December 2018 to identify relevant randomized controlled trials.The data included in the study were independently determined and extracted by two investigators.Primary outcome of interest was the first-attempt puncture success rate.Review Manager 5.3 and TSA 0.9 was used to analyze the collected data.Results A total of 8 randomized controlled trials involving 710 pediatric patients were included in this study.The pooled findings showed that ultrasound guided radial artery puncture,compared with traditional palpation,can significantly increase the first attempt success rate(RR=1.67,95%CI1.35,2.06],P<0.01)and the overall success rate(RR=1.44,95%CI1.22,1.71],P<0.01),decrease the average time to accomplish puncture(SMD=-0.71,95%CI-0.89,-0.52],P<0.01)and incidence of puncture hematoma(RR=0.10,95%CI0.10,0.34],P<0.01).TSA indicated that the current available evidence were conclusive.Conclusion The ultrasound-guided radial arterial puncture in pediatric patients provided a greater chance for success and a lower incidence of adverse events.It is recommended to promote the application of this technology in clinical practice.