【作者】 张莉；

【导师】 陈青山；

【作者基本信息】 暨南大学 ， 流行病与卫生统计学， 2012， 硕士

【摘要】 目的系统评价长期输液患者应用超声引导下改良Seldinger技术与传统盲穿PICC置管的临床效果。方法应用循证医学方法，按照PICO原则构建临床问题，采用计算机检索2001-2011年间Pubmed，Medline，Elsevier-SDOL，The Cochrane Library，清华同方中国知网（CNKI），维普-中文科技期刊系统，万方数据资源系统等数据库收录的有关超声引导下改良Seldinger技术对比盲穿PICC置管的临床效果的文献。按纳入及排除标准共筛选出8篇入选文献，评价所纳入研究的质量后，对纳入的文献按不同的置管方法分为两组，并分别由2名评价者独立地对所纳入文献中有关数据进行摘录后运用RevMan5.1软件进行Meta分析。结果总计纳入8篇符合要求的文献，其中包括6篇随机对照研究和2篇半随机对照研究，共876例，超声引导下改良Seldinger技术组455例，盲穿组421例。Meta分析结果提示：超声引导下改良Seldinger技术PICC置管对比盲穿PICC置管一次穿刺成功率较高[RR=1.22，95%CI（1.14，1.30），P<0.00001]；一次置管成功率较高[RR=1.13，95%CI（1.08，1.18），P<0.00001]；置管后机械性静脉炎的发生率较少[RR=0.06，95%C（I0.02，0.17），P<0.00001]、静脉血栓的发生率较少[RR=0.09，95%CI（0.02，0.50），P=0.005]、穿刺点出血的发生率较少[RR=0.14，95%CI（0.02，0.88），P=0.04]。结论超声引导下改良Seldinger技术行PICC置管对比盲穿置管具有一次穿刺成功率高，一次置管成功率高，置管后机械性静脉炎、静脉血栓和穿刺点出血的并发症发生率低的优点。更多还原

【Abstract】 ObjectiveTo systemically evaluate the clinical efficacy between ultrasound-guided modifiedSeldinger technique and traditional method for peripherally inserted central catheter inpatient with long-term infusion with meta-analysis.MethodsAccording to the method of evidence-based medicine, constructed the clinicalproblem with the PICO principle, used the online search engines to search original studiespublished about the clinical efficacy of ultrasound guided modified Seldinger techniqueversus traditional method for peripherally inserted central catheter that were included inPubmed, Medline, Elsevier-SDOL, The Cochrane Library, CNKI, VIP, Wanfang databasesfrom2001to2011. According to the inclusion and exclusion criteria,8literatures wereenrolled. The quality of these included literatures was evaluated, then according todifferent technique these studies were divided into two groups. After2reviewersextracted the relevant data respectively，Meta-analysis of data extracted by using RevMan5.1software was performed.ResultsA total of8literatures that meet the requirements were enrolled, including6randomized controlled trials (RCT) and2quasi-randomized controlled trials (Quasi-RCT),total876cases, including455patients in the ultrasound-guided modified Seldingertechnique group and421patients in the traditional method group. Meta-analysis resultsshowed: Compared to the traditional method group, ultrasound-guided modified Seldingertechnique group had higher success rate of first puncture(RR=1.22,95%CI1.14to1.30,P<0.00001); higher success rate of first catheter placement (RR=1.13,95%CI1.08to1.18,P<0.00001); less incidence rate of mechanical phlebitis after catheterization (RR=0.06,95%CI0.02to0.17, P<0.00001); less incidence rate of vein thrombosis aftercatheterization (RR=0.09,95%CI0.02to0.50, P=0.005); less incidence rate of puncturesite bleeding after catheterization (RR=0.14,95%CI0.02to0.88, P=0.04). ConclusionCompared with traditional method PICC, PICC performed by ultrasound-guidedmodified Seldinger technique has the advantages of higher success rate of first puncture,higher success rate of first catheter placement, lower complications rate of mechanicalphlebitis、vein thrombosis and puncture site bleeding after catheterization.更多还原