标题：实时超声引导深静脉置管降低导管相关性感染发生率的系统评价

      作者：张华东，陈怀生，王 薇
    (暨南大学第二临床医学院深圳市人民医院留医部重症医学科，广东 深圳 518020)

      卷次： 2015年26卷10期

      【摘要】 目的 评价实时二维超声(TDU)引导深静脉置管降低导管相关性感染(CRI)的有效性。方法 检
索Medline、EMBASE、CENTRAL (the Cochrane Library)、中国生物医学数据库、CNKI和万方数据库(均从开始到
2014年2月28日)。两名评价者分别根据纳入标准筛选、纳入文献。结果 从2 184篇文献中筛查出符合纳入标
准的2篇RCT进行分析。两个试验的 Jadad评分均较低。2篇RCT文章共有1 216例患者，TDU组619例，体表标
志组597例。TDU组穿刺成功率为100%，体表标志组成功率为95%，但是两个RCT存在较大异质性，数据难以
合并。TDU组CRI发生率为 7.75%，体表标志组为 12.90%，两组CRI发生率差异无统计学意义[RR 0.52，95%CI
(0.19, 1.39)]。其中Karakitsos等的研究提示，危重症患者采用TDU引导的深静脉穿刺引起的CRI发生率明显低
于体表标志组[RR 0.65，95%CI (0.46，0.92)]。结论 TDU引导可以提高深静脉穿刺的成功率，且能降低CRI的发
生率。但是研究较少，且由于纳入的对象不同、方法学质量较低等原因而导致结果可信度较低，需要设计更为严
格的随机对照试验以明确TDU引导深静脉穿刺在CRI防治上的作用。

      【关键词】 二维实时超声；深静脉导管；深静脉穿刺；导管相关性感染

      【中图分类号】 R63 【文献标识码】 A 【文章编号】 1003—6350（2015）10—1531—04


Effect of deep vein puncture guided by real-time two-dimensional ultrasound in reducing catheter-related
infection: a meta-analysis.
ZHANG Hua-dong, CHEN Huai-sheng, WANG Wei. Critical Care Medicine, the Second
Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen 518020, Guangdong, CHINA

【Abstract】 Objective To evaluate the clinical effectiveness of deep vein puncture guided by real-time
two-dimensional ultrasound in reducing catheter-related infection. Methods Medline, EMBASE, CENTRAL (the
Cochrane Library), CBM, CNKI, WANGFANG databases were searched according to certain strategies, all from their
inception to Feb 28, 2014. Two reviewers selected and included references respectively. Results Two RCTs were
selected from 2 184 references and were included into analysis. Jadad Scores of both RCTs were low. A total of 1
216 patients (619 cases in TDU group, and 597 cases in landmark group) were included. Success rate of puncture
was 100% in TDU group and 95% in landmark group. But data could not be combined for high heterogeneity be-
tween both RCTs. Incidences of CRI in TDU group was 7.75%, while in landmark group it was 12.90%. The differ-
ence was not statistically significant [RR 0.52，95%CI (0.19, 1.39)]. Results from Karakitsos's study showed that in
patients with critical care, incidence of CRI in TDU was significantly lower than that in landmark [RR 0.65，95%CI
(0.46, 0.92)]. Conclusion TDU might improve success rate of deep vein puncture, and reduce incidence of CRI.
The reliability of the conclusion is reduced due to few studies included, the difference of inclusive population,
low-quality methodologies. To further illustrate this point, strict designation of RCT will be needed for assessing ef-
fects of TDU on reducing CRI.

      【Key words】 Real-time two-dimensional ultrasound; Deep vein catheter; Deep vein puncture; Catheter-related