CAJ | 학술논문

目的：评价实时二维超声(TDU)引导深静脉置管降低导管相关性感染(CRI)的有效性。方法检索Medline、EMBASE、CENTRAL (the Cochrane Library)、中国生物医学数据库、CNKI和万方数据库(均从开始到2014年2月28日)。两名评价者分别根据纳入标准筛选、纳入文献。结果从2184篇文献中筛查出符合纳入标准的2篇RCT进行分析。两个试验的Jadad评分均较低。2篇RCT文章共有1216例患者，TDU组619例，体表标志组597例。TDU组穿刺成功率为100%，体表标志组成功率为95%，但是两个RCT存在较大异质性，数据难以合并。TDU组CRI发生率为7.75%，体表标志组为12.90%，两组CRI发生率差异无统计学意义[RR 0.52，95%CI (0.19,1.39)]。其中Karakitsos等的研究提示，危重症患者采用TDU引导的深静脉穿刺引起的CRI发生率明显低于体表标志组[RR 0.65，95%CI (0.46，0.92)]。结论 TDU引导可以提高深静脉穿刺的成功率，且能降低CRI的发生率。但是研究较少，且由于纳入的对象不同、方法学质量较低等原因而导致结果可信度较低，需要设计更为严格的随机对照试验以明确TDU引导深静脉穿刺在CRI防治上的作用。
목적：평개실시이유초성(TDU)인도심정맥치관강저도관상관성감염(CRI)적유효성。방법검색Medline、EMBASE、CENTRAL (the Cochrane Library)、중국생물의학수거고、CNKI화만방수거고(균종개시도2014년2월28일)。량명평개자분별근거납입표준사선、납입문헌。결과종2184편문헌중사사출부합납입표준적2편RCT진행분석。량개시험적Jadad평분균교저。2편RCT문장공유1216례환자，TDU조619례，체표표지조597례。TDU조천자성공솔위100%，체표표지조성공솔위95%，단시량개RCT존재교대이질성，수거난이합병。TDU조CRI발생솔위7.75%，체표표지조위12.90%，량조CRI발생솔차이무통계학의의[RR 0.52，95%CI (0.19,1.39)]。기중Karakitsos등적연구제시，위중증환자채용TDU인도적심정맥천자인기적CRI발생솔명현저우체표표지조[RR 0.65，95%CI (0.46，0.92)]。결론 TDU인도가이제고심정맥천자적성공솔，차능강저CRI적발생솔。단시연구교소，차유우납입적대상불동、방법학질량교저등원인이도치결과가신도교저，수요설계경위엄격적수궤대조시험이명학TDU인도심정맥천자재CRI방치상적작용。
Objective To evaluate the clinical effectiveness of deep vein puncture guided by real-time two-dimensional ultrasound in reducing catheter-related infection. Methods Medline, EMBASE, CENTRAL (the Cochrane Library), CBM, CNKI, WANGFANG databases were searched according to certain strategies, all from their inception to Feb 28, 2014. Two reviewers selected and included references respectively. Results Two RCTs were selected from 2 184 references and were included into analysis. Jadad Scores of both RCTs were low. A total of 1 216 patients (619 cases in TDU group, and 597 cases in landmark group) were included. Success rate of puncture was 100%in TDU group and 95%in landmark group. But data could not be combined for high heterogeneity be-tween both RCTs. Incidences of CRI in TDU group was 7.75%, while in landmark group it was 12.90%. The differ-ence was not statistically significant [RR 0.52,95%CI (0.19, 1.39)]. Results from Karakitsos's study showed that in patients with critical care, incidence of CRI in TDU was significantly lower than that in landmark [RR 0.65,95%CI (0.46, 0.92)]. Conclusion TDU might improve success rate of deep vein puncture, and reduce incidence of CRI. The reliability of the conclusion is reduced due to few studies included, the difference of inclusive population, low-quality methodologies. To further illustrate this point, strict designation of RCT will be needed for assessing ef-fects of TDU on reducing CRI.