Shu LiPei, Huang Jiao, Liu Jing Chen
Department of Anesthesiology, First Affiliated Hospital of Guangxi Medical University, Nannig, China.
Department of Anesthesiology, First Affiliated Hospital of Guangxi Medical University, Nannig, China
Postgrad Med J. 2021 Jan;97(1143):40-47. doi: 10.1136/postgradmedj-2020-138238. Epub 2020 Nov 4.
Ultrasound guidance has been reported to facilitate the performance of lumbar punctures (LPs). However, the use of ultrasound guidance has not yet received consistent conclusions. We performed a systematic review and meta-analysis to determine the efficacy of ultrasound-guided LPs. PubMed, Embase and the Cochrane Library were searched for randomised controlled trials comparing ultrasound guidance with traditional palpation for LPs in adults. The primary outcome was risk of failed procedures. A random-effects Mantel-Haenzsel model or random-effects inverse variance model was used to calculate relative risks (RRs) or standardised mean differences (SMDs) with 95% CIs. Twenty-eight trials (N=2813) met the inclusion criteria. Ultrasound-guided LPs were associated with a reduced risk of failed procedures (RR=0.58, 95% CI 0.39 to 0.85, p=0.005). No significant heterogeneity was detected (I2=27%) among these trials. It further decreased first attempt to failure (RR=0.43, 95% CI 0.30 to 0.62, p<0.00001), mean attempts to success (SMD=-0.61, 95% CI -0.80 to -0.43, p=0.00001) and incidences of complications of headache and backache (RR=0.63, 95% CI 0.46 to 0.85, p=0.003). Ultrasound guidance is an effective technique for LPs in adults.
据报道，超声引导有助于腰椎穿刺（LP）的操作。然而，超声引导的使用尚未得到一致的结论。我们进行了一项系统评价和荟萃分析，以确定超声引导下腰椎穿刺的疗效。检索了PubMed、Embase和Cochrane图书馆，查找比较超声引导与传统触诊法对成人进行腰椎穿刺的随机对照试验。主要结局是操作失败的风险。采用随机效应的Mantel-Haenzsel模型或随机效应逆方差模型计算相对风险（RRs）或标准化均数差（SMDs）及95%可信区间（CIs）。28项试验（N = 2813）符合纳入标准。超声引导下腰椎穿刺与操作失败风险降低相关（RR = 0.58，95%CI 0.39至0.85，p = 0.005）。在这些试验中未检测到显著异质性（I² = 27%）。它还进一步降低了首次尝试失败的风险（RR = 0.43，95%CI 0.30至0.62，p < 0.00001）、平均成功尝试次数（SMD = -0.61，95%CI -0.80至-0.43，p = 0.00001）以及头痛和背痛并发症的发生率（RR = 0.63，95%CI 0.46至0.85，p = 0.003）。超声引导是成人腰椎穿刺的一种有效技术。
