超声引导下儿科患者中心静脉置管的长轴平面内入路与短轴平面外入路的随机对照试验。
Long-Axis In-Plane Approach Versus Short-Axis Out-of-Plane Approach for Ultrasound-Guided Central Venous Catheterization in Pediatric Patients: A Randomized Controlled Trial.
机构信息
Department of Anesthesiology, Osaka Prefectural Hospital Organization, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan.
Department of Anesthesiology, Kansai Medical University Hospital, Hirakata, Osaka, Japan.
出版信息
Pediatr Crit Care Med. 2020 Nov;21(11):e996-e1001. doi: 10.1097/PCC.0000000000002476.
OBJECTIVES
The aim of this study was to compare the occurrence of posterior wall puncture between the long-axis in-plane and the short-axis out-of-plane approaches in a randomized controlled trial of pediatric patients who underwent cardiovascular surgery under general anesthesia.
DESIGN
Prospective randomized controlled trial.
SETTING
Operating room of Osaka Women's and Children's Hospital.
PATIENTS
Pediatric patients less than 5 years old who underwent cardiovascular surgery.
INTERVENTIONS
Ultrasound-guided central venous catheterization using the long-axis in-plane approach and short-axis out-of-plane approach.
MEASUREMENTS AND MAIN RESULTS
The occurrence of posterior wall puncture was compared between the long-axis in-plane and short-axis out-of-plane approaches for ultrasound-guided central venous catheterization. Patients were randomly allocated to a long-axis group or a short-axis group and underwent ultrasound-guided central venous catheterization in the internal jugular vein using either the long-axis in-plane approach (long-axis group) or the short-axis out-of-plane approach (short-axis group). After exclusion, 97 patients were allocated to the long-axis (n = 49) or short-axis (n = 48) groups. Posterior wall puncture rates were 8.2% (4/49) and 39.6% (19/48) in the long-axis and short-axis groups, respectively (relative risk, 0.21; 95% CI, 0.076-0.56; p = 0.0003). First attempt success rates were 67.3% (33/49) and 64.6% (31/48) in the long-axis and short-axis groups, respectively (relative risk, 1.04; 95% CI, 0.78-1.39; p = 0.77). Overall success rates within 20 minutes were 93.9% (46/49) and 93.8% (45/48) in the long-axis and short-axis groups, respectively (relative risk, 0.99; 95% CI, 0.90-1.11; p = 0.98).
CONCLUSIONS
The long-axis in-plane approach for ultrasound-guided central venous catheterization is a useful technique for avoiding posterior wall puncture in pediatric patients, compared with the short-axis out-of-plane approach.
目的
本研究旨在比较全麻下心血管手术患儿行超声引导下中心静脉置管时，长轴平面内法与短轴平面外法后后壁穿刺的发生率。
设计
前瞻性随机对照试验。
地点
大阪妇女儿童医院手术室。
患者
年龄小于 5 岁行心血管手术的患儿。
干预措施
使用长轴平面内法和短轴平面外法行超声引导下中心静脉置管。将患者随机分配至长轴组或短轴组，分别采用长轴平面内法（长轴组）或短轴平面外法（短轴组）行颈内静脉超声引导下中心静脉置管。排除后，97 例患者被分配至长轴组（n=49）或短轴组（n=48）。长轴组和短轴组后壁穿刺率分别为 8.2%（4/49）和 39.6%（19/48）（相对风险，0.21；95%CI，0.076-0.56；p=0.0003）。长轴组和短轴组首次尝试成功率分别为 67.3%（33/49）和 64.6%（31/48）（相对风险，1.04；95%CI，0.78-1.39；p=0.77）。20 分钟内总成功率分别为 93.9%（46/49）和 93.8%（45/48）（相对风险，0.99；95%CI，0.90-1.11；p=0.98）。
结论
与短轴平面外法相比，长轴平面内法在儿科患者中是一种避免后壁穿刺的有用技术。
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