脐静脉置管尖端X线定位准确性的Meta分析  

Diagnostic accuracy of X-ray imaging for the tip position of umbilical venous catheter:a meta-analysis

作　　者：郑旭 张远 杜娟 罗婧洁 刘雅莉 黑明燕 ZHENG Xu;ZHANG Yuan;DU Juan;LUO Jingjie;LIU Yali;HEI Mingyan(Neonatal Center,National Center for Child Health,Beijing Children's Hospital,Capital Medical University,Beijing 100045,P.R.China;Department of Clinical Epidemiology,National Center for Child Health,Beijing Children's Hospital,Capital Medical University,Beijing 100045,P.R.China)

机构地区：[1]国家儿童医学中心、首都医科大学附属北京儿童医院新生儿中心,北京100045 [2]国家儿童医学中心、首都医科大学附属北京儿童医院临床流行病学与循证医学中心,北京100045

出　　处：《中国循证医学杂志》2023年第12期1387-1392,共6页Chinese Journal of Evidence-based Medicine

基　　金：首都卫生健康发展科研专项(编号:2022-2-2095)。

摘　　要：目的 探讨X线进行新生儿脐静脉置管(UVC)尖端定位的准确性及诊断价值。方法 计算机检索PubMed、Embase、Cochrane Library、CBM、CNKI、VIP和WanFang Data数据库,搜集关于UVC尖端定位的诊断性试验,检索时限均为建库至2023年5月1日。由2名研究员按照纳排标准对检索结果进行筛选、提取数据,并应用QUADAS-2量表进行质量评价;采用Stata 16.0软件进行数据分析,计算合并敏感度、合并特异度、阳性似然比、阴性似然比、诊断优势比、累积受试者工作特征(SROC)的曲线下面积。结果 共纳入12个诊断性试验(n=1 055),其中1篇X线定位的敏感度和特异度均为100%,余下11个研究(n=951)X线定位的合并敏感度为0.7[5%CI(0.6,0.8)]、合并特异度为0.8[95%CI(0.7,0.9)]、阳性似然比为4.0[95%CI(2.0,8.1)]、阴性似然比为0.4[95%CI(0.2,0.6)]、诊断优势比为11[95%CI(3,36)],SROC曲线下面积为为0.8[95%CI(0.8,0.9)]。以第8~9胸椎、第9~10胸椎、膈面+椎体+心影为UVC尖端位置标准进行亚组分析,敏感度分别为0.8[95%CI(0.5,0.9)]、0.5[95%CI(0.4,0.7)]、0.8[95%CI(0.6,0.9)],特异度分别为0.8[95%CI(0.6,0.9)]、0.8[95%CI(0.6,0.9)]、0.91[95%CI(0.79,0.96)],SROC曲线下面积分别为0.9[95%CI(0.8,0.9)]、0.7[95%CI(0.6,0.7)]、0.92[95%CI(0.89,0.94)]。结论 应用X线进行UVC导管尖端定位存在一定误差,通过膈面+椎体+心影综合评估比单独评估椎体的诊断效能高。Objective To evaluate the diagnostic accuracy and efficacy of X-ray for evaluating the tip position of umbilical venous catheterization(UVC).Methods The PubMed,Embase,Cochrane Library,CBM,CNKI,VIP and WanFang Data databases were electronically searched to collect diagnostic tests for UVC tip localisation from inception to 1 May 2023.Two reviewers independently screened the literature according to the inclusion and exclusion criteria,extracted the data and assessed the quality of the studies using the QUADAS-2 tool.Then,meta-analysis was performed by using Stata 16.0 software.ResultsTwelve articles involving 1055 patients were included.The sensitivity and specificity of Negar Yazdani's study were both 100%.The results of the meta-analysis(the remaining eleven articles,n=951)indicated a pooled sensitivity of 0.7(95%CI 0.6 to 0.8),a pooled specificity of 0.8(95% CI 0.7 to 0.9),a positive likelihood ratio of 4.0(95% CI 2.0 to 8.1),a negative likelihood ratio of 0.4(95% CI 0.2 to 0.6)and a diagnostic odds ratio of 11(95% CI 3 to 36)with an area under the cumulative receiver operating characteristic curve of 0.8(95% CI 0.8 to 0.9).A subgroup analysis was performed according to the different methods of judging X,the 8^(th)-9^(th) thoracic,the 9^(th)-10^(th) thoracic and combined judgement of the diaphragmatic plane+the vertebral body+the heart shadow.The sensitivities of the 3 groups were 0.8(95% CI 0.5 to 0.9),0.5(95% CI 0.4 to 0.7)and 0.8(95% CI 0.6 to 0.9);the specificities of the 3 groups were 0.8(95% CI 0.6 to 0.9),0.76(95% CI 0.6 to 0.9)and 0.91(95% CI 0.79 to 0.96).The areas under the cumulative receiver operating characteristic curve were 0.9(95% CI 0.8 to 0.9),0.7(95% CI 0.6 to 0.7)and 0.92(95% CI 0.89 to 0.94).Conclusion Some error is present when determining the catheter tip position by X-ray,in which the evaluation of the umbilical vein catheter tip position through a comprehensive evaluation of the diaphragmatic plane,the heart margin and the vertebral body is more powerful than the evaluation of the verteb

关 键 词：脐静脉 中心静脉导管 X线 新生儿 META分析 诊断性试验 

分 类 号：R722.1[医药卫生—儿科]