Division of Critical Care Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY.
Division of Critical Care Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY.
Chest. 2011 Mar;139(3):524-529. doi: 10.1378/chest.10-0919. Epub 2010 Aug 19.
Ultrasound guidance commonly is used for the placement of central venous catheters (CVCs). The Agency for Healthcare Research and Quality recommends the use of ultrasound for CVC placement as one of its 11 practices to improve patient care. Despite increased access to portable ultrasound machines and comfort with ultrasound-guided CVC access, fewer clinicians are familiar with ultrasound-guided techniques of arterial catheterization. The goal of this systematic review and meta-analysis was to determine the utility of real-time two-dimensional ultrasound guidance for radial artery catheterization.
A comprehensive literature search of Medline, Excerpta Medica Database, and the Cochrane Central Register of Controlled Trials by two independent reviewers identified prospective, randomized controlled trials comparing ultrasound guidance with traditional palpation techniques of radial artery catheterization. Data were extracted on study design, study size, operator and patient characteristics, and the rate of first-attempt success. A meta-analysis was constructed to analyze the data.
Four trials with a total of 311 subjects were included in the review, with 152 subjects included in the palpation group and 159 in the ultrasound-guided group. Compared with the palpation method, ultrasound guidance for arterial catheterization was associated with a 71% improvement in the likelihood of first-attempt success (relative risk, 1.71; 95% CI, 1.25-2.32).
The use of real-time two-dimensional ultrasound guidance for radial artery catheterization improved first-pass success rate.
超声引导常用于中央静脉导管（CVC）的放置。医疗保健研究与质量署建议将超声用于 CVC 放置，作为其改善患者护理的 11 项实践之一。尽管便携式超声机的使用更加便捷，并且对超声引导 CVC 进入的方法也更加熟悉，但熟悉超声引导动脉置管技术的临床医生却较少。本系统评价和荟萃分析的目的是确定实时二维超声引导在桡动脉置管中的应用价值。
两名独立评审员通过 Medline、Excerpta Medica Database 和 Cochrane 对照试验中心注册库进行了全面的文献检索，以确定比较超声引导与桡动脉置管传统触诊技术的前瞻性随机对照试验。提取的资料包括研究设计、研究规模、操作者和患者特征以及首次尝试成功率。进行荟萃分析以分析数据。
共纳入 4 项试验，总计 311 例患者，其中触诊组 152 例，超声引导组 159 例。与触诊方法相比，超声引导用于动脉置管可使首次尝试成功率提高 71%（相对风险，1.71；95%置信区间，1.25-2.32）。
实时二维超声引导用于桡动脉置管可提高首次通过成功率。
