超声引导下中心静脉置管的短轴与长轴进针方法：一项更新的系统评价与荟萃分析
[Short-axis long-axis approach in ultrasound-guided central venous cannulation: an updated systematic review and meta-analysis].
作者信息
Yunyang Han, Zaisheng Qin, Nengxian Shi, Jin H E, Zhenhua Zeng
机构信息
Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
出版信息
Nan Fang Yi Ke Da Xue Xue Bao. 2020 Mar 30;40(3):308-315. doi: 10.12122/j.issn.1673-4254.2020.03.02.
OBJECTIVE
To compare the success rate and safety of the short-axis (SAX) approach and long- axis (LAX) approach to ultrasound-guided central venous cannulation.
METHODS
Electronic bibliographic databases including PubMed, Cochrane Library, Science Direct, and Web of Science were searched for randomized controlled trials comparing ultrasound-guided central venous cannulation via the LAX and SAX approaches published during the period from January, 2011 to October, 2017. We extracted the data from the eligible studies and assessed the first-attempt success rate, overall puncture success rate and complication rate of the two approaches. The relative risk (RR) with the 95% was calculated using a fixed or random effects model.
RESULTS
Seven randomized controlled trials were included for meta-analysis. The results showed that the first-attempt success rate was significantly higher in the SAX group than in the LAX group (RR=1.27, 95%: 1.11-1.46; =0.0005, =49%), but the overall puncture success rate did not differ significantly between the two approaches (RR=1.04, 95%: 0.97-1.10; =0.27, =84%). The incidence of accidental arterial puncture with the SAX approach was significantly lower than that with the LAX approach (RR=1.04; 95%: 1.01-1.08; =0.01, =30%).
CONCLUSION
Ultrasound-guided central venous cannulation via the SAX approach, as compared with the LAX approach, can increase first-attempt success rate and reduce the incidence of accidental arterial puncture.
目的
比较短轴（SAX）法与长轴（LAX）法超声引导下中心静脉置管的成功率及安全性。
方法
检索电子文献数据库，包括PubMed、Cochrane图书馆、Science Direct和Web of Science，查找2011年1月至2017年10月期间发表的比较LAX法与SAX法超声引导下中心静脉置管的随机对照试验。我们从符合条件的研究中提取数据，并评估两种方法的首次穿刺成功率、总体穿刺成功率和并发症发生率。采用固定或随机效应模型计算95%的相对风险（RR）。
结果
纳入7项随机对照试验进行荟萃分析。结果显示，SAX组的首次穿刺成功率显著高于LAX组（RR = 1.27，95%：1.11 - 1.46；P = 0.0005，I² = 49%），但两种方法的总体穿刺成功率差异无统计学意义（RR = 1.04，95%：0.97 - 1.10；P = 0.27，I² = 84%）。SAX法意外动脉穿刺的发生率显著低于LAX法（RR = 1.04；95%：1.01 - 1.08；P = 0.01，I² = 30%）。
结论
与LAX法相比，SAX法超声引导下中心静脉置管可提高首次穿刺成功率并降低意外动脉穿刺的发生率。
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