单平面与实时双平面超声引导在重症监护患者中心静脉置管中的应用：一项随机对照试验。

Single-plane versus real-time biplane approaches for ultrasound-guided central venous catheterization in critical care patients: a randomized controlled trial.

机构信息

From the Medical School of Chinese PLA, No. 28 Fuxing Rd, Haidian District, Beijing, 100853, China.

Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Rd, Haidian District, Beijing, 100853, China.

出版信息

Crit Care. 2023 Sep 23;27(1):366. doi: 10.1186/s13054-023-04635-y.

DOI:10.1186/s13054-023-04635-y

PMID:37742018

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10517529/

Abstract

BACKGROUND

Critical care patients often require central venous cannulation (CVC). We hypothesized that real-time biplane ultrasound-guided CVC would improve first-puncture success rate and reduce mechanical complications. The purpose of this study was to compare the success rate and safety of single-plane and real-time biplane approaches for ultrasound-guided CVC.

METHODS

From October 2022 to March 2023, 256 participants with critical illness requiring CVC were randomized to either the single-plane (n = 128) or biplane (n = 128) ultrasound-guided cannulation groups. The success rate, number of punctures, procedure duration, incidence of catheterization-related complications, and confidence score of operators were documented.

RESULTS

The central vein was successfully cannulated in all 256 participants (163 [64%] man and 93 [36%] women; mean age 69 ± 19 [range 13-104 years]), including 182 and 74 who underwent internal jugular vein cannulation (IJVC) and femoral vein cannulation (FVC), respectively. The incidence of successful puncture on the first attempt was higher in the biplane group than that in the single-plane group (91.6% vs. 74.7%; relative risk (RR), 1.226; 95% confidence interval (CI), 1.069-1.405; P = 0.002 for the IJVC and 90.9% vs. 68.3%; RR, 1.331; 95% CI, 1.053-1.684; P = 0.019 for the FVC). The biplane group was also associated with a higher first-puncture single-pass catheterization success rate (87.4% vs. 69.0% and 90.9% vs. 68.3%), fewer undesired punctures (1[1-1(1-2)] vs. 1[1-2(1-4)] and 1[1-1(1-3)] vs. 1[1-2(1-4)]), shorter cannulation time (205 s [162-283 (66-1,526)] vs. 311 s [243-401 (136-1,223)] and 228 s [193-306 (66-1,669)] vs. 340 s [246-499 (130-944)]), and fewer immediate complications (10.5% vs. 28.7% and 9.1% vs. 34.1%) for both IJVC and FVC (all P < 0.05).

CONCLUSION

Real-time biplane imaging of ultrasound-guided CVCs offers advantages over the single-plane approach for critically ill patients.

TRIAL REGISTRATION

This prospective RCT was registered at Chinese Clinical Trial Registry (ChiCTR2200064843). Registered 19 October 2022.

摘要

背景

危重症患者常需进行中心静脉置管（CVC）。我们假设实时双平面超声引导下 CVC 可提高首次穿刺成功率并减少机械性并发症。本研究旨在比较单平面与实时双平面方法在超声引导下 CVC 中的应用效果。

方法

2022 年 10 月至 2023 年 3 月，256 名需行 CVC 的危重症患者被随机分为单平面（n = 128）或双平面（n = 128）超声引导置管组。记录成功率、穿刺次数、操作时间、导管相关并发症发生率和操作者信心评分。

结果

256 名患者（男 163 例[64%]，女 93 例[36%]；平均年龄 69 ± 19 [13-104 岁]）均成功完成 CVC，其中 182 例行颈内静脉置管（IJVC），74 例行股静脉置管（FVC）。双平面组首次穿刺成功率高于单平面组（91.6%比 74.7%；相对风险（RR）1.226；95%置信区间（CI）1.069-1.405；P = 0.002，IJVC；90.9%比 68.3%；RR，1.331；95%CI，1.053-1.684；P = 0.019，FVC）。双平面组还具有更高的首次穿刺单次置管成功率（87.4%比 69.0%和 90.9%比 68.3%）、更少的非计划穿刺（1[1-1（1-2）]比 1[1-2（1-4）]和 1[1-1（1-3）]比 1[1-2（1-4）]）、更短的置管时间（205 s [162-283（66-1,526）]比 311 s [243-401（136-1,223）]和 228 s [193-306（66-1,669）]比 340 s [246-499（130-944）]），以及更少的即刻并发症（10.5%比 28.7%和 9.1%比 34.1%），无论是 IJVC 还是 FVC 均如此（均 P < 0.05）。