Randolph A G, Cook D J, Gonzales C A, Pribble C G
Division of Pediatric Critical Care, Primary Children's Medical Center, Salt Lake City, UT, USA.
Crit Care Med. 1996 Dec;24(12):2053-8. doi: 10.1097/00003246-199612000-00020.
To evaluate the effect of real-time ultrasound guidance using a regular or Doppler ultrasound technique for placement of central venous catheters.
We searched for published and unpublished research using MEDLINE, citation review of relevant primary and review articles, conference abstracts, personal files, and contact with expert informants.
From a pool of 208 randomized, controlled trials of venous and arterial catheter management, eight published randomized, controlled trials were identified.
In duplicate, independently, we abstracted data on the population, intervention, outcome, and methodologic quality.
Ultrasound guidance significantly decreases internal jugular and subclavian catheter placement failure (relative risk 0.32; 95% confidence interval 0.18 to 0.55), decreases complications during catheter placement (relative risk 0.22; 95% confidence interval 0.10 to 0.45), and decreases the need for multiple catheter placement attempts (relative risk 0.60; 95% confidence interval 0.45 to 0.79) when compared with the standard landmark placement technique.
When used for vessel location and catheter placement real-time, ultrasound guidance or Doppler ultrasound guidance improves success rates and decreases the complications associated with internal jugular and subclavian venous catheter placement.
评估使用常规或多普勒超声技术进行实时超声引导放置中心静脉导管的效果。
我们通过医学文献数据库（MEDLINE）检索已发表和未发表的研究，对相关的原始研究和综述文章进行文献综述，查阅会议摘要、个人档案，并与专家提供信息者进行联系。
从208项关于静脉和动脉导管管理的随机对照试验中，确定了8项已发表的随机对照试验。
我们独立地重复提取了关于研究人群、干预措施、结果和方法学质量的数据。
与标准的体表标志定位技术相比，超声引导显著降低了颈内静脉和锁骨下静脉导管放置失败的发生率（相对危险度0.32；95%可信区间0.18至0.55），降低了导管放置过程中的并发症发生率（相对危险度0.22；95%可信区间0.10至0.45），并减少了多次尝试放置导管的必要性（相对危险度0.60；95%可信区间0.45至0.79）。
当用于血管定位和实时导管放置时，超声引导或多普勒超声引导可提高成功率，并减少与颈内静脉和锁骨下静脉导管放置相关的并发症。
