Tang Lu, Wang Fei, Li Yuxiang, Zhao Liang, Xi Huijun, Guo Zhihong, Li Xiuyun, Gao Chengjie, Wang Jian, Zhou Lingjun
Department of Anesthesiology, General Hospital of Jinan Military Command, Jinan 250031, China.
School of Nursing, Ningxia Medical University, Yinchuan 750004, China.
PLoS One. 2014 Nov 6;9(11):e111527. doi: 10.1371/journal.pone.0111527. eCollection 2014.
Since a previous meta-analysis reported that ultrasound guidance was associated with a higher first-attempt success rate in catheterization of the radial artery, a number of randomized controlled trials (RCTs) have reported inconsistent results. The aim of the present study is to conduct an updated meta-analysis to clarify the role of ultrasound guidance for radial artery catheterization.
A systematic literature search of PubMed, Embase, and Cochrane Central Register of Controlled Trials was conducted using specific search terms. Eligible studies were RCTs that compared ultrasound guidance with traditional palpation for radial artery catheterization. The Mantel-Haenszel method using the random effects model was adopted in this meta-analysis.
Seven RCTs with 482 patients were included. Compared with traditional palpation, ultrasound guidance significantly increased the first-attempt success rate of radial artery catheterization (RR 1.51, 95% CI 1.07-2.14, P = 0.02). Subgroup analyses suggested that the superiority of ultrasound guidance for radial artery catheterization was significant when the technique was operated by experienced users, performed in small children and infants, and on elective procedures in the operating room. In addition, ultrasound guidance significantly reduced mean-attempts to success (WMD -1.13, 95% CI -1.58 to -0.69, P<0.00001), mean-time to success (WMD -74.77s, 95% CI -137.89s to -11.64s, P = 0.02), and the occurrence of hematoma (RR 0.17, 95% CI 0.07-0.41, P = 0.0001).
The present meta-analysis suggests a clear benefit from ultrasound guidance for radial artery catheterization compared with the traditional palpation. Preliminary training and familiarization with the ultrasound-guided technique is needed before applying it for radial artery catheterization, especially for inexperienced operators.
由于之前的一项荟萃分析报告称，超声引导与桡动脉置管首次尝试成功率较高相关，一些随机对照试验（RCT）报告了不一致的结果。本研究的目的是进行一项更新的荟萃分析，以阐明超声引导在桡动脉置管中的作用。
使用特定检索词对PubMed、Embase和Cochrane对照试验中央注册库进行系统文献检索。符合条件的研究为比较超声引导与传统触诊进行桡动脉置管的随机对照试验。本荟萃分析采用随机效应模型的Mantel-Haenszel方法。
纳入了7项随机对照试验，共482例患者。与传统触诊相比，超声引导显著提高了桡动脉置管的首次尝试成功率（相对风险1.51，95%置信区间1.07 - 2.14，P = 0.02）。亚组分析表明，当该技术由经验丰富的使用者操作、用于小儿和婴儿以及手术室的择期手术时，超声引导在桡动脉置管方面的优势显著。此外，超声引导显著减少了成功所需的平均尝试次数（加权均数差 -1.13，95%置信区间 -1.58至 -0.69，P < 0.00001）、成功所需的平均时间（加权均数差 -74.77秒，95%置信区间 -137.89秒至 -11.64秒，P = 0.02）以及血肿的发生率（相对风险0.17，95%置信区间0.07 - 0.41，P = 0.0001）。
本荟萃分析表明，与传统触诊相比，超声引导在桡动脉置管方面有明显益处。在将超声引导技术应用于桡动脉置管之前，尤其是对于经验不足的操作者，需要进行初步培训并熟悉该技术。
