超声引导技术在血液透析患者动静脉内瘘穿刺中应用效果的Meta分析  

Effect of ultrasound-guided cannulation of arteriovenous fistula in hemodialysis patients:a meta-analysis

作　　者：李克佳[1] 肖跃飞[1] 胡军[1] 于俊叶[2] 汤莉琴 沈小芳 张静 刘莹 LI Ke-jia;XIAO Yue-fei;HU Jun;YU Jun-ye;TANG Li-qin;SHEN Xiao-fang;ZHANG Jing;LIU Ying(Department of Nephrology,The Aerospace Center Hospital,Beijing 100049,China;Department of Nursing,The Aerospace Center Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院肾内科,北京100049 [2]航天中心医院护理部,北京100049

出　　处：《中国血液净化》2023年第12期949-954,共6页Chinese Journal of Blood Purification

摘　　要：目的 通过Meta分析评价超声引导技术在血液透析患者动静脉内瘘穿刺中的应用效果。方法 系统检索PubMed、Embase、Cochrane Library、中国知网(CNKI)、万方数据库、维普数据库中关于超声引导与传统盲穿在动静脉内瘘穿刺中效果比较的随机对照试验,检索时限为建库至2022年10月,采用Revman 5.0和Stata 16.0软件进行Meta分析。结果 共纳入8项研究,281例患者,行动静脉内瘘穿刺4992例次。Meta分析结果显示超声引导可提高一次穿刺成功率(RR=1.12,95%CI:1.05~1.20,P<0.001)、降低穿刺后并发症发生率(RR=0.30,95%CI:0.13~0.71,P=0.006)、延长穿刺前的评估时间(MD=75.26,95%CI:68.16~82.36,P<0.001),差异有统计学意义;对穿刺时间(MD=12.91,95%CI:-11.46~37.28,P=0.300)及疼痛感(MD=-0.11,95%CI:-0.67~0.45,P=0.710)的影响差异无统计学意义。结论与传统盲穿法相比,超声引导动静脉内瘘穿刺可提高一次穿刺成功率、降低穿刺后并发症发生率,但对于穿刺时间及疼痛感方面的影响有待进一步大样本的随机对照研究验证。Objective To systematically evaluate the effect of ultrasound-guided cannulation of arteriovenous fistula(AVF)in hemodialysis patients.Methods The databases of PubMed,Embase,Cochrane Library,CNKI,VIP and Wanfang were searched for randomized controlled trials(RCTs)about the efficacy comparison between ultrasound-guided puncture and traditional blind puncture in AVF from the inception to October 2022.Meta-analysis was performed using Revman 5.0 and Stata 16.0 software.Results A total of 8 RCTs with 281 patients and 4992 punctures were included.Meta-analysis showed that ultrasound guidance could improve the success rate of one puncture(RR=1.12,95%CI:1.05~1.20,P<0.001),reduce the incidence of complications after puncture(RR=0.30,95%CI:0.13~0.71,P=0.006),and extended the pre-puncture evaluation time(MD=75.26,95%CI:68.16~82.36,P<0.001);but the time for puncture(MD=12.91,95%CI:-11.46~37.28,P=0.300)and pain perception(MD=-0.11,95%CI:-0.67~0.45,P=0.710)had no statistical significance.Conclusion Compared with traditional blind puncture,ultrasound-guided AVF puncture can significantly improve the success rate of one puncture and reduce the incidence of complications.However,its impacts on puncture time,evaluation time and pain perception needs to be verified by further randomized controlled studies with larger samples.

关 键 词：动静脉内瘘 超声引导 穿刺 血液透析 

分 类 号：R473[医药卫生—护理学]