Olowoyeye Abiola, Fadahunsi Opeyemi, Okudo Jerome, Opaneye Oluwakare, Okwundu Charles
Department of Neonatology, Children's Hospital at Montefiore, Bronx, New York, USA.
Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada.
BMJ Paediatr Open. 2019 Mar 15;3(1):e000412. doi: 10.1136/bmjpo-2018-000412. eCollection 2019.
Lumbar puncture (LP) failure rates vary and can be as high as 65%. Ultrasound guidance could increase the success of performing LP.
To summarise the evidence on the use of ultrasound guidance versus palpation method for LP.
We searched computerised databases and published indexes, registries and references identified from bibliographies of pertinent articles without any language restrictions to find studies that compared ultrasound guidance to palpation method for performing an LP.
Studies were included if they were randomised or quasirandomised trials in neonates and infants that compared ultrasound guidance with palpation method for performing an LP.
Standardised data collection tool was used for data extraction, and two reviewers independently assessed the quality of the studies.
The primary outcome was the risk of LP failure, while the risk of traumatic tap, needle redirections/reinsertions and procedure durations were secondary outcomes.
Data from four studies and 308 participants is included in the analysis. Ultrasound imaging reduced the risk of LP failure, risk ratio of 0.58 (95% CI 0.15 to 2.28), but it was not statistically significant (p=0.44). Ultrasound imaging significantly reduced the risk of a traumatic tap risk ratio of 0.33 (95% CI 0.13 to 0.82) and p=0.02. The included studies had low to moderate quality; the studies differed based on mean age and with variability on outcome definition.
This meta-analysis suggests that ultrasound imaging has no effect in increasing lumbar success but is beneficial in reducing the risk of traumatic taps in neonates and infants.
CRD42017055800.
腰椎穿刺（LP）失败率各不相同，可能高达65%。超声引导可提高LP操作的成功率。
总结超声引导与触诊法用于LP的证据。
我们检索了计算机化数据库以及从相关文章的参考文献中确定的已发表索引、登记处和参考文献，无任何语言限制，以查找比较超声引导与触诊法进行LP的研究。
纳入的研究需为新生儿和婴儿的随机或半随机试验，比较超声引导与触诊法进行LP。
使用标准化数据收集工具进行数据提取，两名评审员独立评估研究质量。
主要结局为LP失败风险，而创伤性穿刺、针头重新定向/重新插入的风险以及操作持续时间为次要结局。
四项研究和308名参与者的数据纳入分析。超声成像降低了LP失败风险，风险比为0.58（95%CI 0.15至2.28），但无统计学意义（p=0.44）。超声成像显著降低了创伤性穿刺风险，风险比为0.33（95%CI 0.13至0.82），p=0.02。纳入研究的质量为低到中等；研究在平均年龄和结局定义的变异性方面存在差异。
这项荟萃分析表明，超声成像对提高腰椎穿刺成功率无作用，但有利于降低新生儿和婴儿创伤性穿刺的风险。
CRD42017055800。
