【罂粟摘要】超声引导颈内静脉置管术术中动态针尖定位与传统长轴平面技术的比较:一项随机对照试验

超声引导颈内静脉置管术术中动态针尖定位与传统长轴平面技术的比较:一项随机对照试验

贵州医科大学  麻醉与心脏电生理课题组

翻译：李奕   编辑：马艳燕  审校：曹莹

1背景：

针尖的连续可视化对于成功的超声引导中心静脉置管术是必不可少的，而动态针尖定位(DNTP)技术使其成为可能。这项随机、双中心试验的目的是比较DNTP和传统长轴平面内(LAX-IP)技术在超声引导下颈内静脉置管术的首次成功率。

2 方法：

在两家三级教学医院接受心脏手术的患者被随机分配到DNTP组或LAX-IP组。颈内静脉置管术由四名麻醉医师完成。主要结果是中心静脉导管置入术的首次成功率。将手术时间和与导管置入术相关的并发症作为次要结果进行比较。

3 结果：

总共分析了142名患者。DNTP组的首次尝试成功率(59/72，81.9%)显著高于LAX-IP组(46/70，65.7%；比值比，2.37；95%置信区间1.09-5.15；P=0.028)。此外，与LAX-IP组相比，DNTP组的针头转向频率较低(P=0.026)。两组的操作时间相当。在与导管置入术相关的并发症方面没有观察到显著差异，包括后壁穿刺、颈动脉穿刺或血肿。

结论：与传统的LAX-IP技术相比，DNTP技术首次尝试颈内静脉导管插入术的成功率明显增高，并且在操作过程中可以更少的调整针头方向。

原始文献来源：Seohee Lee , Jee-Eun Chang , Yoomin Oh, et al. Comparison of dynamic needle tip positioning versus conventional long-axis in-plane techniques for ultrasound-guided internal jugular venous catheterization: a randomized controlled trial.[J].Randomized Controlled Trial Minerva Anestesiol. 2021 Mar;87(3):294-301.

英文原文  

Comparison of dynamic needle tip positioning versus conventional long-axis in-plane techniques for ultrasound-guided internal jugular venous catheterization: a randomized controlled trial

Background:Continuous visualization of the needle tip is essential for successful ultrasound-guided central venous catheterization, and the dynamic needle tip positioning (DNTP) technique enables it. The aim of this randomized, dual-center trial was to compare the first-attempt success rate of ultrasound-guided internal jugular catheterization between the DNTP and conventional long-axis in-plane (LAX-IP) techniques.

Method: Patients undergoing cardiac surgery at two tertiary teaching hospitals were randomly allocated to either the DNTP or LAX-IP group. Internal jugular venous catheterization was performed by four anesthesiologists. The primary outcome was the first-attempt success rate of central venous catheterization. Procedural time and complications related to catheterization were compared as secondary outcomes.

Results:In total, 142 patients were analysed. The first-attempt success rate was significantly higher in the DNTP group (59/72, 81.9%) than in the LAX-IP group (46/70, 65.7%; odds ratio, 2.37; 95% confidence interval 1.09-5.15; P=0.028). In addition, the needle was redirected less frequently in the DNTP group than the LAX-IP group (P=0.026). Procedural time was comparable between the groups. No significant differences were observed in complications related to catheterization, including posterior wall puncture, carotid artery puncture, or hematoma.

Conclusion:The DNTP technique resulted in a significantly higher success rate on the first attempt at internal jugular venous catheterization and required less frequent redirection of the needle during the procedure than the conventional LAX-IP technique.

打赏