摘要
目的通过随机对照研究比较在危重症患者中建立骨髓腔内通路和中心静脉通路的时间、满意度和安全性。方法根据入选标准将患者随机（随机数字法）分入骨髓腔内通路组或中心静脉通路组，分别建立骨髓腔内通路和中心静脉通路，并经上述通路给予药物或液体治疗，记录第一次穿刺是否成功、穿刺时间、满意度、并发症等数据。结果本试验共人组24例患者，骨髓腔内通路组和中心静脉通路组各12例，年龄、性别、BMI在两组间差异无统计学意义，骨髓腔内通路组和中心静脉通路组中诊断为休克和心脏骤停者分别占83．3％、58.3％。骨髓腔内通路组和中心静脉通路组第一次穿刺成功率分别为91．7％、66．7％（P=0．158），建立骨髓腔内通路和中心静脉通路的时间分别为（74．9±43．7）s、（944．0±491．5）s（P〈0．01），骨髓腔内通路组操作者和中心静脉通路组操作者对使用器械的满意度分别为（8．0±1．1）分、（7．2±0．8）分（P=0．053），对总体操作的满意度分别为（3．7±0．7）分、（3．9±0.3）分（P=0．377），两个组的患者均未观察到穿刺相关的并发症。结论骨髓腔内通路的第一次穿刺成功率明显高于中心静脉通路，平均穿刺时间远小于中心静脉置管，且操作简单，实用性更强，在危重症患者急救过程中，在外周血管通路难以建立时，骨髓腔内通路可作为一种重要的桥接方法，快速建立血管通路，赢得抢救时机。
Objective To compare the time consumed for the procedure done, satisfaction and safety of the establishment of intraosseous （IO） access and central intravenous line placement （CVL） in critically ill patients using a randomized controlled trial. Methods The patients were randomly divided into the IO access group versus CVL group according to the inclusion criteria. The IO access and CVL were established, respectively for medicine or fluid administration. The success rates at the first attempt, time required for procedure completed, satisfaction and complications were recorded. Results During the study period, 24 patients were enrolled, and divided equally and randomly into IO group （n=12） and CVL group （n=12）. There were no significant differences in age, gender, BMI between the two groups. The patients with shock and cardiac arrest accounted for 83.3 % in IO group and 58.3 % in CVL group, respectively. The success rates at the first attempt was 91.7 % in IO access group versus 66.7 % in CVL group （P=0.158）. the time required for procedure done was significantly shorter in IO access group （74.9 ±43.7）s compared with CVL group （944.0 s±491.5 s） （P〈0.01）. The satisfaction of operators at the instruments used was 8.0±1.1 for IO access group versus 7.2±0.8 for CVL group （P=0.053）. The overall satisfaction of the operators at the entire course of procedure was 3.7 ±0.7 in IO access group versus 3.9±0.3 in CVL group （P=0.377）. Complications were not observed during the study period in the two groups. Conclusions The success rate at the first attempt was significantly higher in IO access group compared with CVL grouThe mean time consumed for procedure completed in IO group was much shorter than that in CVL group, and the operation was simple and practicable. During the emergency care of critical patients, if the peripheral intravenous line placement was difficult to establish, and IO access could be a choice of alternative used as a bridging procedure to rapidly establish t
作者
刘艳艳
汪宇鹏
祖凌云
郑康
李楠
赵一鸣
郑亚安
高炜
Liu Yanyan;Wang Yupeng;Zu Lingyun;Zheng Kang;Li Nan;Zhao Yiming;Zheng Yaan;Gao Wei(Department of Cardiology,Peking University Third Hospital,Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides,Ministry of Health,Key Laboratory of Molecular Cardiovascular Sciences,Ministry of Education,Beijing 100191,China;Department of Emergency,Peking University Third Hospital,Beijing 100191,China（Zheng K,Zheng YA;Clinical epidemiology research center of Peking University Third Hospital,Beijing 100191,Chin)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2018年第8期901-904,共4页
Chinese Journal of Emergency Medicine
关键词
骨髓腔内通路
中心静脉通路
危重症
血管通路
第一次穿刺成功率
穿刺时间
满意度
并发症
Intraosseous vascular access
Central venous catheterization
Critical disease
Blood vessel
Success rates on first attempt
Procedure time
Satisfaction
Complications
