成年患者紧急抢救中骨髓腔输液通路与外周静脉输液通路应用效果Meta分析  

Meta-analysis of the application effect of intraosseous infusion access and peripheral intravenous infusion access in the emergency resuscitation of adults

作　　者：盛婉婷 李祥云 杨小惠 王洁 赵林芳[1] Sheng Wanting;Li Xiangyun;Yang Xiaohui;Wang Jie;Zhao Linfang(Intravenous Therapy Specialty,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310020,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院静脉治疗专科,浙江杭州310020

出　　处：《中国急救医学》2024年第10期913-920,共8页Chinese Journal of Critical Care Medicine

摘　　要：目的分析骨髓腔(IO)输液通路与外周静脉(PIV)输液通路在成年患者紧急抢救中的应用效果。方法计算机检索PubMed、Web of Science、the Cochrane Library、Embase、CINAHL、CNKI、CBM、VIP和万方数据库中有关IO输液通路与PIV输液通路在成年患者紧急抢救中应用效果的研究,检索时限均为建库至2023年6月。由2名研究者独立筛选文献、提取资料并评价纳入文献质量后,采用RevMan 5.3软件进行Meta分析。结果共纳入26篇文献,38988例患者。Meta分析结果显示,与成年患者紧急抢救时建立PIV输液通路比较,建立IO输液通路可缩短成功建立输液通路时间及血压回升时间,提高一次置管成功率,并发症发生率低,但常压下输液速度较慢,且自主循环恢复成功率较低(P<0.05),加压下输液速度差异无统计学意义(P>0.05)。结论基于现有证据,推荐成年患者在紧急抢救时可首选IO输液通路,并使用外部压力装置或输液泵进行持续的液体输注,待完成抢救或成功建立PIV输液通路后予以拔除。IO输液通路在成年患者紧急抢救过程中的有效性还需更多高质量、大样本的研究进一步讨论。Objective To analyze the effectiveness of intraosseous(IO)infusion access versus peripheral intravenous(PIV)infusion access in the emergency resuscitation of adults.Methods Computer searches of PubMed,Web of Science,the Cochrane Library,Embase,CINAHL,CNKI,Wanfang Data,VIP and CBM for the studies on the effectiveness of IO infusion access versus PIV infusion access in the emergency resuscitation of adults were conducted.The time limit was from the establishment of the database until June 2023.Meta-analysis was performed by using RevMan 5.3 software after two investigators independently screened the literatures,extracted the data and evaluated the quality of the included literatures.Results A total of 26 literatures with 38988 patients were included.Meta-analysis showed that the establishment of IO infusion access can shorten the time required for successful establishment of infusion access and blood pressure to return to the normal level,improve the successful rate of first catheterization,the incidence of complications was low,but the speed of infusion at normobaric pressure was slow,the successful rate of the recovery of spontaneous circulation(ROSC)was low(P<0.05),compared with the establishment of PIV infusion access during emergency resuscitation of adult patients.The difference in infusion speed under pressurization was not statistically significant(P>0.05).Conclusions Based on the available evidences,it is recommended that during emergency resuscitation of adult patients,IO infusion access should be preferred and continuous fluid infusion should be provided by using an external pressure device or infusion pump,and then was removed after the completion of resuscitation or successful establishment of PIV.It is important to note that the effectiveness of IO infusion access during emergency resuscitation in adult patients needs to be further discussed in more high-quality,large-sample studies.

关 键 词：骨髓腔输液 外周静脉输液通路 危重症 急诊 循证医学 

分 类 号：R472[医药卫生—护理学]