在新生儿的腰部穿刺的定位
Sara Pessano1, Matteo Bruschettini2,3, Marcus Glenton Prescott4
1Neonatal Intensive Care Unit, Department Mother and Child, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
The Cochrane database of systematic reviews
|October 23, 2023
概括
与坐姿相比,在新生儿的腰部刺穿时,侧侧位可能不会显著改变成功率,但会增加胸肌梗塞和氧气不和的风险. 需要进一步的研究来确认益处和危害.
科学领域:
- 新生儿护理 新生儿护理
- 儿科手术 儿科手术 儿科手术
- 临床研究方法论临床研究方法论
背景情况:
- 腰部穿刺 (LP) 是新生儿常见的诊断和治疗程序,高失败率影响患者的结果.
- 选择患者的位置,主要是横向和坐着,可以影响LP的成功和安全.
- 在LP期间改善新生儿结果的最佳位置存在不确定性.
研究的目的:
- 为了评估侧,坐着和倾斜的位置在新生儿的腰部穿刺的好处和危害.
- 为了比较新生儿腰部穿刺期间不同患者姿势的疗效和安全性.
- 评估定位对手术成功和腰部穿刺新生儿不良事件的影响.
主要方法:
- 随机对照试验 (RCT) 和准RCT的系统审查和元分析.
- 纳入标准:新生儿 (至月经后46周) 经历腰部穿刺.
- 主要结局:成功的首次试图LP,总试图和胸肌梗塞发作;用于证据确定性的GRADE方法.
主要成果:
- 侧卧位在第一次尝试成功与坐着相比几乎没有差异 (低确定性证据).
- 与坐着相比,侧卧位可能会增加胸肌梗塞和氧气脱的发作 (中度确定性证据).
- 与俯卧姿势相比,侧卧式下垂可能会减少第一次尝试的成功 (低确定性证据).
结论:
- 在新生儿中,侧卧位在第一次尝试成功时与坐姿相比几乎没有任何优势,并且可能会增加像胸等不良事件.
- 有证据表明,侧面部可能不如倾斜的位置在最初的腰部穿刺尝试中取得成功.
- 建议使用经过验证的疼痛量表进行进一步的研究,以充分了解新生儿在不同腰部穿刺位置的益处,危害和患者体验.
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