置入中长导管与PICC并发症发生率比较的Meta分析-现代医学

置入中长导管与PICC并发症发生率比较的Meta分析

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

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.

参考文献：

[1] 王法颍,蔡丽娜,范宇莹,等.中线导管在住院患者中的应用研究进展[J].现代临床医学,2023,49(5):397-400.
[2] XIE J,XU L,XU X,et al.Complications of peripherally inserted central catheters in advanced cancer patients undergoing combined radiotherapy and chemotherapy[J].J Clin Nurs,2017,26(23-24):4726-4733.
[3] ADAMS D Z,LITTLE A,VINSANT C,et al.The midline catheter:a clinical review[J].J Emerg Med,2016,51(3):252-258.
[4] LESCINSKAS E H,TRAUTNER B W,SAINT S,et al.Use of and patient-reported complications related to midline catheters and peripherally inserted central catheters[J].Infect Control Hosp Epidemiolo,2020,41(5):608-610.
[5] 高娇,李珊珊,庞湃,等.中线导管对Ⅲ期喉癌术后患者不良事件及血流变学的影响[J].中国继续医学教育,2020,12(21):168-171.
[6] XU T,KINGSLEY L,DINUCCI S,et al.Safety and utilization of peripherally inserted central catheters versus midline catheters at a large academic medical center[J].Am J Infect Control,2016,44(12):1458-1461.
[7] 林文顶,陈巧玲,赵慧玲,等.超声引导下留置静脉中线导管与PICC在ICU中的应用效果分析[J].中国医疗器械信息,2023,29(12):80-82.
[8] 贺金薇,何金爱,王鹤锦,等.中长导管与PICC在静脉输液早期并发症比较的Meta分析[J].中国实用护理杂志,2023,39(24):1907-1913.
[9] HIGGINS J P T,GREEN S.Cochrane handbook for systematic reviews of interventions version 5.1.1[M].London:John Wiley & Sons,2011:187-241.
[10] CAPARAS J V,HU J P.Safe administration of vancomycin through a novel midline catheter:a randomized,prospective clinical trial[J].J Vasc Access,2014,15(4):251-256.
[11] KLEIDON T M,SCHULTS J A,WAINWRIGHT C,et al.Comparison of midline catheters and peripherally inserted central catheters to reduce the need for general anesthesia in children with respiratory disease:a feasibility randomized controlled trial[J].Paediatr Anaesth,2021,31(9):985-995.
[12] 于延玲,姚宏燕,戴美玲,等.中线导管在神经外科ICU患者中的应用效果[J].临床医学研究与实践,2023,8(27):142-145.
[13] 张美兰.超声引导下改良型中等长度导管在晚期恶性肿瘤患者中的应用效果[J].中国医学创新,2022,19(19):113-116.
[14] 徐兵,杨丽娟,戴明红,等.中等长度导管在危重新生儿静脉输液中的应用效果[J].循证护理,2022,8(9):1276-1278.
[15] 季万丽.中线导管在Ⅲ期喉癌术后静脉治疗中的应用效果观察[J].中国现代药物应用,2022,16(14):56-58.
[16] 赵敏艳,吴伶慧,刘红,等.中线导管在脑卒中重症患者中的应用效果[J].血管与腔内血管外科杂志,2021,7(11):1368-1372.
[17] 陈香.改良型中等长度导管与PICC在胃肠道肿瘤患者围手术期中的应用比较[J].当代临床医刊,2021,34(4):60-77.
[18] 徐丹.中线导管在脑出血患者静脉治疗中的临床应用研究[J].当代护士(下旬刊),2020,27(7):130-132.
[19] 李兰,李现文,蔡志云,等.意外伤害患儿上腔静脉置入20 cm中长导管的效果观察[J].护理学报,2020,27(16):52-55.
[20] 杨美华,袁顺琼,甘秀妮,等.中长导管在急性胰腺炎患者静脉输液治疗中的临床效果观察[J].检验医学与临床,2019,16(6):729-731.
[21] 毛珍珠,胡敏,周伟,等.中线导管在脑出血患者静脉治疗中的应用[J].现代医院,2018,18(9):1390-1392.
[22] 刘佳佳,张娟,谭蕾.改良型中等长度导管与PICC在胃肠道肿瘤患者围手术期中的应用比较[J].护理实践与研究,2018,15(7):143-145.
[23] 李彬,邓丽娜,赵蕾,等.老年住院患者静脉中长导管临床相关并发症调查[J].中国老年保健医学,2018,16(2):130-133.
[24] 车肖文,唐晓莲,颜婧.晚期肿瘤静脉营养支持患者应用改良型中等长度导管与PICC效果比较[J].临床与病理杂志,2020,40(9):2341-2344.
[25] 朱颖,赵燕,周燕妮,等.外周中等长度导管在神经外科患者中的应用效果[J].实用临床医药杂志,2021,25(2):40-42,58.
[26] 刘宗淑,宋秀荣,孔林芳,等.超声引导下改良塞丁格技术植入改良外周静脉中长导管的临床应用效果[J].中外医学研究,2019,17(35):173-175.
[27] 吕梦颖,卢大松,李香梅,等.不同锻炼方式预防老年肿瘤患者PICC相关性血栓的研究[J].现代医学,2021,49(1):64-68.
[28] 中国研究型医院学会护理分会项目组.中等长度静脉导管临床应用专家共识[J].中华护理杂志,2020,11(55):43-49.
[29] BAHL A,KARABON P,CHU D.Comparison of venous thrombosis complications in midlines versus peripherally inserted central catheters:are midlines the safer option?[J].Clin Appl Thromb Hemost,2019,25:1076029619839150.
[30] URTECHO M,TORRES ROLDAN V D,NAYFEH T,et al.Comparing complication rates of midline catheter vs. peripherally inserted central catheter.A systematic review and meta-analysis[J].Open Forum Infect Dis,2023,10(2):ofad024.
[31] KAGAN E,SALGADO C D,BANKS A L,et al.Peripherally inserted central catheter-associated bloodstream infection:risk factors and the role of antibiotic-impregnated catheters for prevention[J].Am J infect Control,2019,47(2):191-195.
[32] 张雨虹,邱艳茹,万永慧.PICC置管后首次换药时间的系统综述和Meta分析[J].现代医学,2024,52(4):618-627.
[33] 盛婉婷,杨小惠,于卫华,等.不同长度的中线导管在静脉穿刺困难患者中的应用研究[J].护理与康复,2024,23(1):13-16,22.
[34] 张贤,夏琪,王卫,等.隧道干预PICC置管预防相关并发症的研究现状和进展[J].现代医学,2022,50(9):1191-1194.
[35] 刘纬华,白文辉,杜晓宁,等.成人中线导管堵塞预防的最佳证据总结[J].护理学报,2022,29(22):46-51.
[36] MOUREAU N.Hydrophilic biomaterial intravenous hydrogel catheter for complication reduction in PICC and midline catheters[J].Expert Rev Med Devices,2024,21(3):207-216.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录