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置入中长导管与PICC并发症发生率比较的Meta分析
作者:李沛亚1  尹晓华2  胡梦寒1  金胜楠2 
单位:1. 河北中医药大学 护理学院, 河北 石家庄 050000;
2. 河北省中医院 护理部, 河北 石家庄 050011
关键词:中长导管 经外周静脉中心静脉导管 并发症 Meta分析 
分类号:R472
出版年·卷·期(页码):2024·52·第十期(1490-1498)
摘要:

目的: Meta分析置入中长导管与经外周静脉穿刺中心静脉导管(PICC)常见并发症,比较中长导管和PICC的安全性。方法: 检索中国知网(CNKI)、万方、维普(VIP)、中国生物医学文献数据库(CBM)、PubMed、Embase、Cochrane library数据库中关于患者置入中长导管与PICC并发症发生率比较的随机对照试验,并通过RevMan 5.4软件进行Meta分析。结果: 纳入19篇文献,共1 798例研究对象。Meta分析结果显示,中长导管静脉血栓发生率(RR=0.21,95%CI 0.10~0.44)、导管相关血流感染发生率(RR=0.19,95%CI 0.08~0.42)与PICC相比,差异均有统计学意义(均P<0.000 1);静脉炎发生率(RR=0.85,95%CI 0.53~1.36)、导管外渗发生率(RR=0.85,95%CI 0.46~1.57)、导管移位发生率(RR=0.74,95%CI 0.41~1.34)、导管堵塞发生率(RR=0.93,95%CI 0.58~1.50)、导管脱出发生率(RR=0.90,95%CI 0.35~2.31)与PICC相比,差异均无统计学意义(均P>0.05)。在中长导管≥20 cm亚组中,中长导管静脉血栓发生率(RR=0.20,95%CI 0.08~0.49)、导管相关血流感染发生率(RR=0.16,95%CI 0.06~0.44)与PICC相比,差异均有统计学意义(均P<0.05)。结论: 中长导管静脉血栓、导管相关血流感染发生率低于PICC,亚组分析中长导管长度≥20 cm的静脉血栓、导管相关血流感染发生率同样低于PICC,但使用中长导管不能降低静脉炎、导管外渗、导管移位、导管堵塞、导管脱出发生率。

Objective: To perform a meta-analysis comparing the common complications of insertion of midline catheter and peripherally inserted central venous catheter(PICC), and to evaluate the safety of midline catheter and PICC. Methods: Retrieve data from China National Knowledge Infrastructure(CNKI), Wanfang Date, VIP database, Chinese Biology Medicine(CBM), PubMed, Embase and Cochrane Library. Comparison of randomized controlled trials and Meta-analysis were conducted using RevMan 5.4 software. Results: Data from 19 papers, totaling 1, 798 subjects, were included. The Meta-analysis showed that the incidences of venous thrombosis(RR=0.21, 95%CI 0.10-0.44) and catheter-related bloodstream infection(RR=0.19, 95%CI 0.08-0.42) for insertion of midline catheters were statistically significant(both P<0.000 1). There were no significant differences in the incidence of phlebitis(RR=0.85, 95%CI 0.53-1.36), catheter extravasation(RR=0.85, 95%CI 0.46-1.57), catheter migration(RR=0.74, 95%CI 0.41~1.34), catheter occlusion(RR=0.93, 95%CI 0.58~1.50), or catheter dislodgement(RR=0.90, 95%CI 0.35-2.31) compared with PICC(P>0.05). Among the midline catheter ≥20 cm subgroup, the incidence of venous thrombosis(RR=0.20, 95%CI 0.08-0.49) and catheter-related bloodstream infection(RR=0.16, 95%CI 0.06-0.44), both were statistically significant(both P<0.05). Conclusion: The incidence of venous thrombosis and catheter-related bloodstream infection in midline catheters is lower than that in PICC. In the subgroup analysis of midine catheters with a length of ≥20 cm, the incidence of venous thrombosis and catheter-related bloodstream infection is also lower than that in PICC.However, the use of midline catheters cannot reduce the incidence of phlebitis, catheter extravasation, catheter migration, catheter occlusion, and catheter dislodgement.

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