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 本试验共入组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(Jp=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.

abstractsObjective 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 the vascular access and win the rescue opportunity.