CAJ | 학술논문

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。
목적：계통평개초성인도여전통체표정위재소인정맥천자치관효과차이。방법계산궤검색Cochrane도서관、PubMed、Highwire、EMbase、CBM、CNKI등중외생물의학수거고，수집유관응용초성인도여전통체표정위재소인정맥천자치관효과적림상수궤대조시험，검색문헌일기위1993년1월-2013년1월。채용Cochrane 계통평개방법，안조납입화배제표준한정연구대상，제취유효수거후채용RevMan 5．0연건진행Meta분석。결과공납입응용초성인도하여전통경내정맥천자효과적림상수궤대조연구6항（공319례）。결과현시：초성인도조용시경단[가권균수차（ WMD）＝-6．10，95％CI （-8．10～-4．10）]，천자성공솔경고[WMD＝5．06，95％CI（2．33～10．97）]，상시차수경저시즉가천자성공[WMD＝-1．05，95％CI（-1．43～-0．68）]，병발증발생솔경저[WMD＝0．13，95％CI（0．55～0．34）]。결론재조작자능숙련장악초성의사용전제하，여전통체표정위천자치관상교，초성인도하가축단용시、제고성공솔、감소천자차수、차유효강저병발증。우기대우전통체표정위천자곤난적병례，초성인도하천자유현저우세，치득림상추엄응용。
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 .