超声引导技术在儿科人群桡动脉置管中的有效性：系统评价和随机对照试验的荟萃分析。
Efficacy of ultrasound-guided technique for radial artery catheterization in pediatric populations: a systematic review and meta-analysis of randomized controlled trials.
机构信息
Department of Ultrasound, Liaocheng People's Hospital, Liaocheng City, Shandong Province, China.
Department of Orthopaedics, Liaocheng People's Hospital, No 67 Dongchang West Road, Liaocheng City, 252000, Shandong Province, China.
出版信息
Crit Care. 2020 May 6;24(1):197. doi: 10.1186/s13054-020-02920-8.
BACKGROUND
The use of an ultrasound-guided technique for radial arterial catheterization has not been well established in pediatric patients. We conducted a systematic review and meta-analysis to evaluate the efficacy of the ultrasound-guided technique for radial artery catheterization in pediatric populations.
METHOD
A systematic review of PubMed, Medline, Embase, and the Cochrane library was performed from their date of inception to December 2019. In this meta-analysis, we conducted online searches using the search terms "ultrasonography," "ultrasonics," "ultrasound-guided," "ultrasound," "radial artery," "radial arterial," "catheter," "cannula," and "catheterization." The rate of the first-attempt and total success, mean attempts to success, mean time to success, and incidence of complications (hematomas) were extracted. Data analysis was performed with RevMan 5.3.5.
RESULTS
From 7 relevant studies, 558 radial artery catheterizations were enrolled, including 274 ultrasound-guided and 284 palpation catheterizations. The ultrasound-guided technique could significantly improve the rate of first-attempt and total success (RR 1.78, 95% CI 1.46 to 2.18, P < 0.00001; RR 1.33; 95% CI 1.20 to 1.48; P < 0.00001). However, there was significant heterogeneity for the total success rate among the included studies (I = 67%). The ultrasound-guided radial artery catheterization was also associated with less mean attempts and mean time to success (WMD - 1.13, 95% CI - 1.58 to - 0.69; WMD - 72.97 s, 95% CI - 134.41 to - 11.52) and lower incidence of the hematomas (RR 0.17, 95% CI 0.07 to 0.41).
CONCLUSIONS
The use of the ultrasound-guided technique could improve the success rate of radial arterial catheterization and reduce the incidence of hematomas in pediatric patients. However, the results should be interpreted cautiously due to the heterogeneity among the studies.
背景
在儿科患者中，桡动脉置管术的超声引导技术尚未得到很好的确立。我们进行了系统评价和荟萃分析，以评估超声引导技术在儿科人群中进行桡动脉置管的效果。
方法
对 PubMed、Medline、Embase 和 Cochrane 图书馆进行了系统评价，检索时间从建库至 2019 年 12 月。在这项荟萃分析中，我们使用了“超声检查”、“超声”、“超声引导”、“桡动脉”、“桡动脉”、“导管”、“套管”和“置管术”等检索词进行在线搜索。提取首次尝试和总成功率、平均尝试成功率、平均成功时间和并发症（血肿）发生率。使用 RevMan 5.3.5 进行数据分析。
结果
从 7 项相关研究中，共纳入 558 例桡动脉置管术，其中 274 例采用超声引导，284 例采用触诊引导。超声引导技术可显著提高首次尝试和总成功率（RR 1.78，95%CI 1.46 至 2.18，P<0.00001；RR 1.33；95%CI 1.20 至 1.48；P<0.00001）。然而，纳入研究的总成功率存在显著异质性（I=67%）。超声引导桡动脉置管术还与较少的平均尝试次数和平均成功时间相关（WMD-1.13，95%CI-1.58 至-0.69；WMD-72.97 秒，95%CI-134.41 至-11.52），且血肿发生率较低（RR 0.17，95%CI 0.07 至 0.41）。
结论
超声引导技术的应用可提高桡动脉置管术的成功率，并降低儿科患者血肿的发生率。然而，由于研究之间存在异质性，结果应谨慎解释。
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