Meta分析评价超声引导下与解剖标志引导下颈内静脉插管术

发布时间：2018-03-17 15:20

本文选题：颈内静脉　切入点：置管　出处：《昆明医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:在临床上,中心静脉穿刺置管是一项常用的操作技术,在不同的科室如ICU,手术室,急诊科等被用于诊断、监测和治疗。颈静脉、锁骨下静脉和股静脉是常用的穿刺置管部位。颈内静脉是最常见的穿刺置管部位之一。该项meta分析对超声引导下颈内静脉穿刺置管和根据解剖位置进行颈内静脉穿刺置管进行了比较,并在现有的研究基础上拓展了理论依据。目的:本文的目的是评价超声引导下(二维/多普勒)与解剖标志引导下颈内静脉置管术在有效性、安全性和并发症发生率方面的差异性。方法:在数据库如PubMed,ISI知识网,EMBASE,和OVIDEMB以及在一些有关的杂志和相关参考文献列表中通过手动搜寻出大量的相关随机对照实验。选择随机对照试验,提取数据并根据最新的指南进行数据分析。设定纳入标准和排除标准用于随机对照实验的选择。结果:根据纳入标准,共有30个随机对照实验包括4504个样本被纳入该项meta分析。两组之间存在显著统计性差异,如总成功率RR =1.10,95%CI:1.06-1.14;首次穿刺成功率 RR =1.56,95%CI:1.31-1.85;穿刺直至成功RR=-0.65,95%CI:-0.82 to-0.48;成功穿刺所用时间RR=-1.32 95%CI:-1.86 to-0.77;总并发症发生率 RR=0.34,95%CI:0.21-0.55;穿刺动脉 RR=0.23,95%CI:0.14-0.36;血肿RR=0.22,95%CI:0.13-0.3;穿刺完成时间 RR=-189.47,95%CI:-389.38 to 10.44,气胸 RR= 0.20,95%CI:0.07-0.55,但在血胸发生率RR = 0.25 95%CI:0.05-1.20和臂丛神经刺激发生率RR= 0.30,95%CI:0.03-2.62方面并没有显著统计学意义。结论:与解剖标志引导下颈内静脉穿刺相比,使用超声引导下穿刺方法增加了总体成功率和首次穿刺成功率,降低了并发症如穿刺动脉,血肿,气胸并缩短了成功穿刺所用时间和减少了尝试穿刺次数。
[Abstract]:Background: central venous catheterization is a common technique in clinic. It is used for diagnosis, monitoring and treatment in different departments such as ICU, operating room, emergency department, etc. The subclavian vein and femoral vein were commonly used to place the catheter, and the internal jugular vein was one of the most common catheterization sites. The meta analysis was used to analyze the ultrasound guided internal jugular vein catheterization and internal jugular vein according to the anatomical position. The puncture tube was compared, The purpose of this paper is to evaluate the effectiveness of ultrasound guided internal jugular vein catheterization (2D / Doppler) and anatomic marker guided internal jugular catheterization. Differences in safety and incidence of complications. Methods: a large number of related randomized controlled trials were manually searched in databases such as PubMedus ISI knowledge network Embass and OVIDEMB, as well as in a list of relevant journals and related references. Select a randomized controlled trial, Extraction of data and analysis of data in accordance with the latest guidelines. Selection of inclusion and exclusion criteria for randomized controlled trials. Results: according to inclusion criteria, A total of 30 randomized controlled trials, including 4,504 samples, were included in the meta analysis. There were significant statistical differences between the two groups. For example, the total success rate RR = 1.1095 CIV: 1.06-1.14; the first puncture success rate RR= 1.5695CI1: 1.31-1.85; the puncture up to the successful RR-0.659595 CI-0.82 to-0.48; the time taken for successful puncture to RR=-1.32 95CI-1.86 to 0.77; the total complication rate RR0.34995 CIW 0.21-0.55; the puncture artery RRR0.2395CI0.14-0.36; hematoma RRn0.2295CIU 0.13-0.3; the time of completion of the puncture RR-189.4775 to 10.449.38 to 10.4444; the pneumothorax RR= 0.20CI0.07-0.55. There was no significant difference in the incidence of hemothorax (RR = 0.25 95 CI: 0.05-1.20) and brachial plexus stimulation (RR = 0.3095 CI: 0.03-2.62). Conclusion: compared with internal jugular venipuncture guided by anatomic markers, there was no significant difference in the incidence of hemothorax and brachial plexus stimulation. Ultrasound-guided puncture method increased the overall success rate and the first puncture success rate, reduced the complications such as puncture artery, hematoma, pneumothorax and shortened the time of successful puncture and reduced the number of attempts.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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